Mortgage_Akins A +-��. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year I
F a
a - t FOR DEDUCTION FROM ASSESSED VALUATION Gibson P W as lc I 2019
it State Fon143709(R13/10-15)
' Prescribed by Department of Local Government Finance
INSTRUCTIONS: 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 deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 0 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 the County Auditor of the county 0 County Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Stephen Akins and Janet L.Akins
Taxing District _ ' number/legal description Record nu beery Pa a nu bberr
etee P& o .is Sey 26-12-19-400-000.423-027/PT N SE 19 2 10 .66 AC or_C q
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?
5158,080.00 ,LJXes ❑ No
If no.what is Ns/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 pro in question:Annually Assessed
al Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FILED
501 N.Cross Pointe Blvd., Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code) AUG 2 8 2019 1
Does applicant own proper/to anY If yes,what county? What Taxing District? Has tie deduction been requested If yes,state amount of deduction
other cavity
in trotuta? ❑Yes o .. . ONO
A person is not entitled to this deduction unless the person has a balance on the pG eSbbr rQbttetu cpjtra4t i0Q@btedness that is recorded in the county
recorder's office(including any home equityTine of credit that is recorded in the county recorder's office)thetis ThL'basis for the deduction_
COUNTY AUDITOR
Deduction approved in the am u t
20 I 20 20 20 20 I 20
Signature of County Auditor County D `,9'
Gibson
I/We certify under penalty o perjury that t bove and foregoing information is true and correct and that the applicant is a resid nt of In Lana and
owner I contract buyer of the aforementioned property on date application is filed.
o - • __ Date(mgn_th d�y,year)
&78/
Full res' e ss of applicant(number and street,city,state,and ZIP code) 9
403 N. Eastview St, Fort Branch, IN 47648
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 street city,state,and ZIP code)
The penalties for perjury can include unprisonnient up to two and a half years and a fine not to exceed S 10,O ).