HomeMy WebLinkAboutMortgage_Kplb •,_" 4,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t� FOR DEDUCTION FROM ASSESSED VALUATION RECEIVED
ti State Form 43709(R14/1-20) Gibson Patoka 2023
e, Prescribed by Department of Local Government Finance DEC2 Z 2022
�1� I 1 File Mark
INSTRUCTIONS:To be filed in person or by mail. 1/J0,
r ed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property County Auditor
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jason Kolb
Taxing District Key number/legal description Record number Page nu`p Q/
028 26-12-07-403-001.132-028/Summers Add 7,Gibson County O O.o- 0000 J O CJ
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
93,279.00 ® Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: F1.1.,;;E:F,:I uestion:Annually Assessed
❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller O 20L�9
Mortgage Research Center,LLC dba Paddio DEC
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 'L --
1400 Forum Boulevard,Columbia,MO 65203 /i��� &.
Name of assignee or other owner or holder of mortgage GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property i any If yes,what county? What Taxing District? Has this deduc' een requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes EJ No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c t indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 " 20 20 20 20
Signature of County Auditor Nf j(4` S County \ ^ D�e^(rrt th,day, e ^
30
I/We certify under the penalty of perjury that the abo nd foregoing information is trtlrtd correct and that the applicant a resid nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
g//// n (owner's full name)y, Date(month,day,year)
�Z� December 13, 2022
resident address of applicant(number and street,city,state,and ZIP code)
602 South Seminary Street,Princeton,IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
December 13, 2022
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF T•AGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee o ontract seller
Jason Kolb Mortga a Researc enter o 73
Date tiled(month,day,year) Amou ebtedness Tax Distri C7
Columbia T' a 3,27s.00 02 in
4 dim — z
Key number/legal description Evansvill 47715 p VI
26-12-07-403-001.132-028/Summers Add 7,Gibson ounty Q
Signature of County Auditor/County Recorder County Date(month, ,year)
a)
5 5