HomeMy WebLinkAboutMortgage_Ricketts (2) .�- > STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
d/ i County Township Year
,/ - FOR DEDUCTION FROM ASSESSED VALUATION
��/1 State Form 43709(R12/6-14) 26
,,,-.- Prescribed by Department of Local Government Finance
INSTRUCTIONS: 4py ayp !r-
rk
To be filed in person or by mail. S.�../
orm fled 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 tpAVOpgryisZO's ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. JJ��ff �0 11 ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the de tton is ugl t —
See reverse side for additional instructions and qualifications.Applicant(owner(owner or contract buyer-see restrictions on reverse side)
Mitzi A Ricketts GIBSON COUNTY AUDITOR •
Taxing District Key number/legal description Record tuber Page numbA
26-13-34-303-001.021-006 / Pt. SW SW 34-2-9 4.01 Ac. t� /J� S -
Assessed value of real property as of Mortgage/Conuact indebtedness unpaid as of Mortgage/Cation indebtedness unpaid as of le tae applicant the sole
e
Year March 1,current year��� 6 O O date of application legal or equitable owner?
Yes 0 N
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 Accessed
0 Real Property ❑ AnnuallyAssessed > •
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Acceptance Capital Mortgage Corporation
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
101 Plaza East Blvd Evansville, IN 47715
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 in any If y ,what county? What Taxing District? Has this deduction been requested If yes,stateamount of deduction
in Indiana? 11rnrn /1 I1__�A / on property
year for?other county .LJ Yes El No YII r/Kn+1/1` wmentyeaR ❑Yes El 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/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.
:Ina - ..--es Inane) n el-6.14.1-
Date(m th tlay y/ear)
s
dr /L/ jP FWI resident addr= /applicant(number t city,state,and ZIP code)
4400 So 850 East Oakland 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.