HomeMy WebLinkAboutMortgage_Bieker ,.,,,.o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
._ j; State Form 43709(R12/6-14) 1 009 2019,e Prescribed by Department of Local Government Finance �T� A File Mark
INSTRUCTIONS:
To be filed in person or by mail. ����ff11\\// OO oQ o�nnto Form fled with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the dadtktiCn4S 4AI, t.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with thg/tlpup , f f the county ❑ County Recorder
where the property is located during the twelve(12)months before March 31 of a P've tion ssought
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Kyle N. & Alyssa L. Bieker
Taxing District Key number/legal description R number Page number
009 26-18-36-403-000.661-009/West Hgts 4th Add Lot 16, Gibson County 0(6 l ,,,-,4,-,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year d of pplication legal or equitable owner?
/ 0 Yes ❑ No
If no,what is his I 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
❑y 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)
PO Box 918 Evansville, IN 47706
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? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes ❑No current year?El ❑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
• R
Signature C my Auditor •ll
7 County 1_ _ Date(month,day year) ^ /y
I/We certify under the penalty of perjury that that the� ng information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Sig ture(owner's full name) Date(month,day year)
Nk , - 'bi 11/16/18
Full resident address of applicant(number and et,city,state,and ZIP code)
1004 Monica Court, Haubstadt, IN 47639
Person authorized by duly executed Power of Attomey 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 S10,000.