HomeMy WebLinkAboutMortgage_Gooch (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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1. FOR DEDUCTION FROM ASSESSED VALUATION Gibson P a 2022
State Form 43709(R14/1-20) RECEIVED
Prescribed by Department of Local Government FinanceO
Q P}, �� File Mark
INSTRUCTIONS: To be filed in person or by mail. !(a� S �� ' DEC 2 2 2022 F rim Iled with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property
is located on or before January 5 of the calendar ye to which(he properttaxes are first due and payable. ounty Recorder
See reverse side for additional instructions and qualifications. �...nlh
Applicant(owner or contract buyer-see restrictions on reverse side)
Kimberly A. Gooch
Taxing District Key number/legal description Record number Page number
ulket---- (V Nvi 26-12-07-102-001.151-028/Lot(s): Pt 146,Original Plan, Parcel
ID(s): 26-12-07-102-001.151-028 7-O O % . S`1 3 3
Pa
ssessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is a applicant the sole
assessment date,current year assessment date,current year date of application legs or uitable owner?
$0.00 $132,947.00 Yes 0 No
If no,what is his/her exact share of interest? T If owned with someone other than spouse,indicate with whom
��1�J
If name on record is different than that of applicant,indicate be ■ ,E D Is e property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller DEC 3`0 2022
111
Acceptance Home Mortgage LLC, ISAOA/ATIMA
Address of mortgagee or contract seller(number and street,cites te,and ZIP cgaje) ,�j-�,L. _- '
1221 N Royal Ave, Evansville, IN 47715 C[�G I��Qa�
Name of assignee or other owner or holder of mortgage GIBSUN COUNTY AUOITt
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio een requested If yes,state amount of deduction
other county ❑Yes El No on property for Yes El No
in Indiana? current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cont ct 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 2 20 20 20 /h�''��20 /r)7
Signature of County Ayptgt (`f.J `3 County Date mo V (/"V-
V tl Gibson 14
1/We certify under penalty of perjury that the abov and foregoing information is true and correct and that the applicant is a said n ndiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owns (full nam� r Date onth,day, ear
Vi J /``S 1 X'- Da-a--
Full resident address of applicant(numbs and street,city,state,and ZIP code)
996 S Old State Road 65, Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
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 510,000.
RECEIPT FOR FILING STATEMENT OF MO'TGAGE OR CONTRACT INDEBTEDNESS
Name of applicant N-• e of mortgagee or contract seller
Kimberly A.Gooch Acc-.tance Home Mortgage LLC, ISAOA/ATIMA
Date Date filed(month,day,year) Amount of indebtedness Taxict^ /� X
$132,947.00 a v [�� cart 33
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Key number/legal description n
26-12-07-102-001.151-028/Lot(s): Pt 146,Orly I Plan,Parcel ID(s):26-12-07-102-00 1-028 '" IT�
Signature of County Auditor/County Recorder County Date(month,day,year) No ..<
Gibson CI
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