HomeMy WebLinkAboutMortgage_Farrington k STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
/41,.._. t FOR DEDUCTION FROM ASSESSED VALUATION
Sate Fonna370g(R /10. Johnson 2016
Prescribed by Depai3rtment
t5)of Local Government Finance ip I i to pm
INSTRUCTIONS: ! J f / File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduct pgip sqq t�f1 t1 77
Must be filed or postmarked with the County Auditor or County Recorder of the county/M. 6 roperry is ❑ County 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 Coun Auditor of the unty
where the property is located during the twelve(12)months before March 31 of each '
COUNTY ug t.
See reverse side for additional instructions and qualifications.
Applicant(owner or conhad buyer-see restrictions on reverse side) CiaCON AUDITOR
Tina Farrington and John C. Farrington
Taxing District Key number/legal description Rlu�be{ Page rum
Johnson 26-23-16-200-002.675-024 UU �/L _
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant sole
assessment date.current year assessment date,current year date of application legal or equitable owner?
30,300.00 305,600.00 El 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 ddferent than that of applicant,indicate below: Is the property in question:Annually Assessed
2 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,dry,state,and ZIP code)
Does applicant own property ine.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 NI No current year? ❑Yes 0 N
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 recorders 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
drrzdam er/co er of the . orementioned property on date application is filed.
e) ///j I Date(z/nt,,n a .eaa,r7
Full resident address of appl' -�umber and sleet,dry,stet ,antl ZIP code)
Lot 20 Warrento- lace South Subdivision
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 sheet,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.