HomeMy WebLinkAboutMortgage_Ervin q„ —STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS__County—Township_ Year
FOR DEDUCTION FROM ASSESSED VALUATION _
1• State Form 43709(R13/10-15) Gibson Princeton 2018
\\„- Prescribed by Department of Local Government Finance
INSTRUCTIONS: F g T�F1I
ye rk
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 deduction is sought. C C in
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly fsP 1 �]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 County Auditor of the coy ty
where the property is located during the twelve(12)months before March 31 of each year the deduction''r�(
See reverse side for additional instructions and qualifications. G1RCQnt fin
Applicant(owner or contract buyer-see restrictions on reverse side) ..J.ITY AJDITOK
Jesse W. Ervin
Taxing District Key number/legal description Record number Page number
Princeton . 26-12-07-403-001.492-028 ab \1 — 13Vy1
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,anent year assessment date,current year date of application legal or equitable owner?
69,100.00 65,000.00 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
TA 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 in a 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/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. .
Signet _(owners lull name) r - , Date(month,day,year) .
2i/ -- 9 . 8 -17
eF ' esident address of applicant(number and street,city,state,and ZIP code)
525 S Race St., Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 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 S10,000.