HomeMy WebLinkAboutMortgage_Hull (4) te;�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Yea
`" - a FOR DEDUCTION FROM ASSESSED VALUATION
�I ' ,. 4)%1 State Form 43709(R13/10-15)
' .Z.:--; 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 ❑ 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)
Brant S. Hull and Christina L. Hull, husband and wife
Taxing District Key number/legal description Record number Page number
Montgomery 26-12-18 -302-00 0 , 1$$-- O2g Zxo k 01
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?
$191,675.00 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
0 Real Property ❑ Annually Assessed
_Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `.', },
Old National Bank 1
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) • .�(
101 Northwest Fourth, Evansville, IN 47708VI
Name of assignee or other owner or holder of mortgage 151-
Address of assignee(number and street,cit. I,,
Does applicant own property in any If yes luctionfo been requeste ttf�, date amount of deduction
other county + /l n , `T-- 1 `— ? otY4k�
in Indiana? ❑Yes ❑✓ No (�T/�J -LW4 ❑Yes kY�Nb
A person is not entitled to this deduction, or contract indebtedness that is recorded in the county
recorder's office(including any home ec ,) , /o I I ice)that is the basis for the deduction.
Deduction approved in the amount of: (l
20 20 20 20 20 20 20
Si ur of Count Auditor County Date(month,day,year)
9� Y / ' ?
�.V/We certify tanker the penalty erjury that the above and foregoing 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.
Signature(own s full na e) / / /�/� Date(month,day,year)
_ pii,,,,,,tiyiz,) i_/� 02/28/2020
Full resident address of applicant(number and street, 'y,state,and ZIP code)
10247 W SR 165, Owensville, IN 47665
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.