HomeMy WebLinkAboutMortgage_Rainey • S�ATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS gAp
Coon Tow i.. �L!
t ' FOR DEDUCTION FROM ASSESSED VALUATION �'�Ir - '
1 Plate Form 43703 077218-f a) girr�
1 by Department of Local Government Finance File Mark
® INSTRUCTION '
To be ltledh Ye or bymaa Fapn Ned vdth: H ('s
Meng Dater 7)Rail property Must be completed and dated N the calendar year for whldl the dedudion Is sought
Malt be Cad or postmarked with theCounty Auditor or County Reo,njer of the county where the '0
µmpeltyk locatedon or before January 5 Wtheimrnedla'ely succeeding calendar yeu. •2)Mob/7e/Manufactured Homes not amass teas Real Properly. Must 54 with the County Audio,of the O f ty ,�
tyenssoughtopertybbcatatl durup the hrofve(11)months before March 31 of each year dm . '� 1%/i��
'e cLbnlenelint t - NTY
Sae reverse sidle hvadbDonal instructions acct qualTiaflona A
AppMent(ovmnera a buyer-see restktons an reverse side) UO)TOR
Jason A.Rainey: rid Michelle M.Rainey •
Taxing District , Key number/tedel deaoiptcn 2&22-10-100-002.48&024/3035W 1200 Reed number Pa b
• S.Haubstadt,Indiana 47839 a6/4 - 7�
Assessed value of reel property as cf Wayne I Cantrad lndebtadness unpaid as of Mortgage l Cadred Indebtedness unfold east Is the apparent No sole
March 1,current ye . March 1,anent yeas dab of eppacat'on hoar or equtab'e owner/
$257,000.00 D yes 0 No
If no,what Is Na I her exact share of Nbrest? If owned MN someone other than spouse,Indicate YON whom
. . - Unarm on record Is Ilferent then that of appacant,Indicate bedw • Is the property In q esCon:Annually Assessed
- 0 Real Property D$Annua'yAssessed
Name of monaaoeep mated sera
Mobile Home(IC 8-1.1-7)
Old National Bank' -
Address of=duegt tr contract eater(number end street ally stab,and ZIP cede)
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PO Box 918;Evansville,IN 47708 I .
Name of assq;we of other over or Holder of mortgage t
j
Address of assyneejusumber and sweet,dry,state,and ZIP code)
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other DOea appacanl oven tamely a yes,what county? What Team District? Hasgda dododbn been requested dyes,state amount of
on properly for decheion
In[Winne? D Y 0 No
Fa. . cement yeer7 ❑ Yes 0 No
A person is not enti)(ed to this deduction unless the personhas a-balance on the person's mortgage orcantract indebtedness that fa'recordedN the comfy
recorder's office(argtddmg any home equity E a ofaedlt that is recorded In the mmtyrecorders office)that Is the basis for the dedurlon
1 COUNTY AUDITOR
Deductoi approved to emaurd of .
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® 20 1 , 20 20 - 20 20 20 i 20
Slg,ub:re of Comb' dibr 1
Carry Data(n,aiN,day,y,rad
11 We certify under penalty of perjury that the above and foregoing Information Is true and correct end that the applicant Is a resident of Indiana and
owner/contrectbuyer of the aforementioned property on date application is Ned.
Slgraama(owners hie name)
Date(month,day,year):
FW re ident eddrest at appazant(um 5 r and"la�t's ,Hate, code) ����^' '�P
3035 W 1200 S, aubstadt,IN 47839
Pasco aV.lertrad duly exautsd Power of Attorney or by IC 6-1.1-12-0.7 Date(enact,day,year):
Address of aultorG I pagan tau:rar and street dry state,end ZIP code)
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Thepenal5es for peYryrycan include Imprisonment up to two and a half years and a fine not to exceed 310,000. • '
RECEIPT FOR FlLING STATEMENT OF(MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant ' Name of mortgagee or contract seer
Jason A.Ralney and Michelle M.Ralney • Old National Bank
D.v=filed(mgnN,daljbysab ....... .....
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10/712016 : $257,000.00
Key number/legal d eon 28.22-10-100-002488-024/3035 W12005,Haubstadt,Indiana 47839 '-A
Signawre of Corny 1 yudforl County Recorder County I Date(month,day,rea); /U Cc,
Gibson G
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1 ?0i6
•. G/es cOUN�Y
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AUDITOR
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