HomeMy WebLinkAboutMortgage_McEllhiney (12) .E='-• ,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
177-,+me 1.) FOR DEDUCTIONS)FROM ASSESSED VALUATION Gibson" Patoka 2019
`� /�4 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ,P County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 0 County Recorder
property is 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 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)
Damon McEllhiney , Levyn McEllhiney
Taxing District Key number/legal description Record number Page number
Patoka 26-11-14-100-002.879-027 2Q1el - Lt0 $2
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 I I or equitable owner?
$215,000.00 250,000.00 Yes 0 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: I.t+-property in question:Annually Assessed
■ Real Property 0 Annually Assessed
Mobilep Home(IC 6-1.1-7)
Name of mortgagee or contract seller 14-1
I °
Old National Bank 7
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) •
PO Box 918, Evansville, IN 47706 OCT 07 2019
Name of assignee or other owner or holder of mortgage
• saileN:e4: it------- - .
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUDITOR
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 ❑No current year? 0 Yes '0 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)
bC)i � sod I0 —7 l9
I/We certifyunder the penaltyof perjurytha e 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.
-srSigna (owner's full name) _ Date(month,day,year)
faro . \ 1.__ ______ �, 2 . 09/27/19
F sident a dress of applicant(number and s eet,city,state,and ZIP code)
2072 SW White Church Roa , Princeton, IN, 47670
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 imprisonment up to two and a half years and a fine not to exceed$10,000. 43069