HomeMy WebLinkAboutMortgage_Phillips (2) /^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fit \ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) Gibson Columbia 2017
• ', Prescribed by Department of Local Government Finance
INSTRUCTIONS:' - .. File Mark
To be filed in person or by mail, g o with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sou T e �
Must be filed or postmarked with the County Auditor or County Recorder of the county where th ro I.I ' •unty Auditor
located on or before January 5 of the immediately succeeding calendar year ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the•.µnty �_ Z ,c
where the property is located during the twelve(12)months before March 31 of each year the deductio t 7&VUJry u
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) )li, a ir
Nathan J Phillips and Shay C Phillips !rw 1 �'�^^
Taxing District Key number l legal description GIBBON 1Sef+UU1 number
Columbia 26-14-20-200-001.582-006 �Le 3580
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?
332,700 220,000 0 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: Is the property in question:Annually Assessed
1Z Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
One Main Street, Evansville, IN 47708
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property i ny If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 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 contract 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 County Date(month,day,year)
•
I I We fertify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
own: I coptract buyer of the aforementioned property on •ate application is filed.
,//- ryy.''r' na • Date(month .ay,y,-r)
bier aQ._� •la I'SW? d. / /�
till resident address of appl .n w her and street, ty,state,and ZIP code)
1550 S 1300 E, Oa land City, IN 47660 .
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$10,000.