HomeMy WebLinkAboutMortgage_Alvarez •^•4% STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
Se%�,_ FOR DEDUCTION FROM ASSESSED VALUATION ' ':,
r State Form 43709(R13/10-15) Ibs a b-)-• 2017
•-�,•„ . Prescribed by Department of Local Government Finance
INSTRUCTIONS: SEP 8 FII7z,4Fark
To be filed in person or by mail C 1F1orrm filed with:
Filing Dates: 1) Real Property: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 p ••=)n, 's-kIrni,,2 aunty Auditor
located on or before January 5 of the immediately succeeding calendar year. County
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Aur PbSPb1cGONNTY A. IOR' Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Michael N Alvarez
Taxing District Key number/legal description Record number Page number
Haubstadt 26-18-36-402-000.393-009 ,QO/b 373
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?
135,000 85,000 p 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
0 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 PDO t r `
Address of assignee(number and street,city state,and ZIP code) ht d, N
Does applicant own property in If yes,what county? What Taxing District? 1" (� N r�I v''?Z � :deduction
other county r.. r e `l ^ 1
in Indiana? ❑Yes No 1�'
A person is not entitled to this deduction unless the person has a balance on the per,,... I OO U D$ - din the county
recorder's office(including any home equity line of credit that is recorded in the county recoroe,_ U
COUNTY AUDITOR
Deduction approved in the amount of: '' a..../b
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify 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
owner/contract buyer of the aforementioned property on date application is filed. h/r/Sre fu dame) Date(m ^tl d3 3/JLe
Fun resident address o a cant number and sheet,city,state,and ZIP code) 1X,
103 N West St., Haubstadt, IN 47639
Person authorized by duly executed Power of Attorney or by IC 8-1.1-12-0.7 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.