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HomeMy WebLinkAboutMortgage_Stevens (4) 0 F •,.o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION S'�..` �; State Form 43709(R13/10-15) • Prescribed by Department of Local Government Finance INSTRUCTIONS: Mark To be filed in person or by mail. I L e l ortn fled with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought... Must be tiled or postmarked with the County Auditor or County Recorder of the county where genjoyty.A. El County Auditor located on or before January 5 of the immediately succeeding calendar year. I�H� Z018 ❑ 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 uction is soup rt. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR Stevens, Brian and Stevens, Emily Taxing District Key number/legal description Re r umb - Page num�r Johnson 26-22-15-400-002.427-024 ` b /0 J 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? $350,650.00 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 F4 Real Property ❑ AnnuallyAssessed 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 any 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 I9 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 I We certify under th= •en-Ity of perjury that t - -•• . . • •regoing information is true and correct and that the applicant is a resident of Indiana and -- owner/ -• buy-r oft - afor-••- oned property on date application is file. i• •full na - Date Jr day, . '`'� ��� )1o' Ip ull'went address o applicant(number and street,city,state,and ZI—ode) / 2919 W. 1200 S., Haubstadt, IN 47639 Person authorized by duly executed Power ofA`tomey 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.