HomeMy WebLinkAboutMortgage_Peach Jr �0--" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' ' .. FOR DEDUCTION FROM ASSESSED VALUATION
g7„ 'rtk'; Gibson Ft.Branch 2020
State Form 43709(R13/10-15)
s+ 4' Prescribed by Department of Local Government Finance RECEIVED
File Mark
INSTRUCTIONS: �� el al- 1 C JUN - 4 2020 Form d 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. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the ❑ 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)
Jeffrey L. Peach,Jr.
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-19-18-303-000.462-026 2020 r2 15 I
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 le al or equitable owner?
$103,500.00 144,337.00 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: Is`��he r in question:Annually Assessed
p al.1 ro rty 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellerFIL ,..„
Mortgage Masters of Indiana,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) JUN 0 4 2020
501 N. Cross Pointe Blvd, Evansville, IN 47715 _
Name of assignee or other owner or holder of mortgage 40:ee.--4—
•
DIBSON COUNTY i. '' 4OR
Address of assignee(number and street,city,state,and ZIP code)
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? ❑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
Signature of County Audito r County 1 C Date( r7nt. 'ZOa2.®
—\If.
I/We certify un r the penalty of perjury that tha foregoing information is t u and correct and that the applican iis`'{a esident of Indiana and
owner/contr uyer of th aforementioned property on date application is filed.
Signature(owne uH name), rn 1,,,,-` •--1 Date(month,day,year)
-- - - 05/27/20
-Full residen address of applicant(number and street,city,state,and ZIP code)
104 N Lincoln Street, 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 imprisonment up to two and a half years and a fine not to exceed$10,000. ' 44729