HomeMy WebLinkAboutMortgage_Sealsd, "��o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count 7ownship Year
-�._._ � FOR DEDUCTION FROM ASSESSED VALUATION I
}• � Stata Fwm 43709 (R71 / 609)
�� Prescnbed Oy Depamnent of Local Govemmem Finance
File Mark
INSTRUC710N5:
To be !led in person or by mail. Fofm filed with:
Filing Dafes: i) Real Property Must be comp/eted and dated in (he calendar year /or which (he deduction is sought.
Must 6e Filed wifh the County Auditor or Counfy Racorder o/ the cnunty where the property is located ❑ Counry Auditor
on or be�ore January 5 0l the immediately succeetling calendar year. ❑ Counry Recorder
2) Mo6ile /Manutacfured Homes nof assessed as Real PropeRy: Musflle with the County Auditor o7 fhe
cnunry whera the property is located dunng 1he twelve (12) months before March 37 oleach year the
deducfion is sought.
See reverse side /or additional instmctrons and auali�cations.
Applicant (ownei w oontrdd buyer- see resficfions on reverse sitle)
Ean J. Seals and Lindsay J. Mondino
Tating Distria Key numDer / la9al des�siption Recortl num0er Pa9e number
Center Townshp 2G13-20.200-001.504-004 / Lots 22 8 23 Lakewood Hills Sub. I�strunent
Assessed value d real property as o/ Mwtgaga / ConhaG iMebteEness unpaid as of Mortgage / ConbaU indebtedness unpaiG as of Is Ne apprman lhe e c
Mar� 1, wrtentyear Marfh 1, wrtent year"'�' —'�- "'" '�date of appGCation legal or equitabla owneR
$144,000.00 ❑� Yes ❑ No
If no, what is his / her ezacl share ol interest? If owne0 wiN someone olher ihan spouse, inCifate wiN whom
If name on recorC a tlitferent Nan Nat of appticant. indicata bebw: Is Ne pfoperty in question: MnuaRyASSesseC
❑� Real Property ❑ MnuallyASSessed
Mobile Home QC 6-1.1-7)
Name ol mortgagea or conVact seAer
Oid National Bank
ACEress of rtartgagee or mnVaci seAer (numGer errd streef, city, sta:e, aM ZIP coEe)
1 Main Street, Evansville, IN 47708
Name of assignee or oNer owner or holder of rtqrtgage
AEEreu of assignee (number antl s:reet. dry, state, end ZIP wCe)
Daes applinm v.m pmperty in any oNer II yes, what counry7 What Ta�in9 Oistrial Has Nis tlatluNon been requested on Oroperty
coun inlnd'ura? forwrtent eaR
ry ❑ Yes ❑� No Y
❑ Yes ❑ No
COUNTY AUDITOR
Oetluction apprweC in Ne amount of:
20 _ 20 _ 20 20 _ 20 _ 20 20 _
Si9nawre of CounryAUtlitor Counry Date (rtronfh, Oay, yea�
I I We ceNfy under lhe penalry of perjury Nat the above and foregoing intortnation is We and cortect and ffiat the appliwnt is a resident of Indiana and
owner I wntracl buyer o( the aforementioned pmperty on date application is 61ed.
Sgnature (ownef !u➢ ame) Dala ( , da a�
�.,�, J� (,
Full25ident a0dress of applican[ (numDeranO sfreet ciry, stafe, and Z!P wde)
1897 S. Lakewood Cir., F2ncisco, IN 47649
Parson auUrorizeE by duty eYewted Pawer of Attomey or by IC fi7.142-07 Date (mm1h, tlay. yea�
Atltlress ot authwrzed person (number andsbeet, ciry, iWte, aiW ZlPCade)
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