HomeMy WebLinkAboutMortgage_Kerns At T STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°''=�=--fa FOR DEDUCTION FROM ASSESSED VALUATION
ec -y._1 :
"`\,_t,'�_�;, .� State Form 43709(R12/6-14) Gibson Johnson 2020
'. "%�- Prescribed by Department of Local Government Finance
refs
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 ❑✓ 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 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)
Jennifer Kerns and Joel Kerns
Taxing District Key number/legal description Record number Page number
009 26-19-31-303-000.352-009/ORIGINAL PLAN 202 PT/203/204, Gibson County d Lot 0000 C O^(„
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole�"Y✓
March 1,current year March 1,current year date of application legal or equitable owner?
159900.00 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
❑✓ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National BankFI Address of mortgagee or contract seller(number and street,city,state,and ZIP code) A',.w-A I
One Main Street, Evansville, IN 47708
Name of assignee or other owner or holder of mortgage DEC it 9 2019
Address of assignee(number and street,city,state,and ZIP code) RR ee �u
Does applicant own property in any If yes, hat county? What taxing District? ciLPAPdcdSct�tkej,Yec lafio es,state amount of deduction
other county VIA
� /` on property for �\
in Indiana? Yes `�No VIA�latag (01 current year? es ID No �UV
A person is no entitled to this deduction unless the persoli 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 1,31 County \ Date(month,day,year)
MI lif)
I/We certify under the penalty of perjury th trt ove and foregoing information is'rfue and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. _
ignature I ner's full name) _ - Date(month,day,year)
�� 12/2/2019
Full resi. " -f.6-ss of appli nt tuber and s eet,,city,state,and ZIP code)
46 South Vine Street, Haubstadt, IN 47639
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.