HomeMy WebLinkAboutMortgage_Davis (4) t : *a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co nty" Township Year
FOR DEDUCTION FROM ASSESSED VALUATION _ _ 1 `
6'� F .`�' State Form 43709(R13/10-15) RECEIVED g�On ^-1 '--)0'Z0
�.xi_%4' Prescribed by Depa nt of Local Government Finance ` ' G
INSTRUCTIONS: yr�cryt r I • JUN 2 2 2020 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)
Andrew R. Davis and Staci A. Davis, husband and wife
Taxing District Key number/legal description Record nu er Page
wmter
Ft Branch 26-19-19-103-001.191-026 20 2 -0
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?
$93,500.00 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
FOld National Bank i__ 9 I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ii,
One Main St., Evansville, IN 47708 `t "
Name of assignee or other owner or holder of mortgage JUN $ 3 2020
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? GIBS . r for Y as pigp �nAka:I :Med If yes,state amount of deduction
other county
in Indiana? •❑Yes 0 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 :. ir
20 20 20 20 20
Signature of Coun 4o[r,.r, 1 EE. III
County 1 O - Date onti d year 02o
I,We certify unser the penalty of perjury at the above and foregoing information is tr nd correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig t e(owner's full me) Date(month,day,year).
Aust.: G , CAA
,,-r.n 7 � 06/15/2020
Full resident address of applicant(number an street,city,state,and ZIP code)
7981 S Andee LN, 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.