HomeMy WebLinkAboutMortgage_Huelsman (3) Acefti , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ounty ownship Year
ire r NS. FOR DEDUCTION FROM ASSESSED VALUATION
.6sd -
Vr r1 y. I; State Form 43709(R13/10-15) / /1,50X�, 2020
� 4.`yy w..A.
\`,r ^, Prescribed by Department of Local Government Finance File Mark
eas
INSTRUCTIONS:
To be filled in person or by mail. Form fil 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 located on or before January 5 of the immediately succeeding calendar year. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the 0 County Recorder
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 C. Huelsman
Taxing Di trict Key number/legal description 26-18-36-404-000.358-009/503 W Elm St. Record number Page number
¶f 3 ,4 S Haubstadt, Indiana 47639 (—aegV
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?
$154,500.00 ❑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 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city,state, and ZIP code) IL 1 9
PO Box 918, Evansville, IN 47706
•
Name of assignee or other owner or holder of mortgage
JUN 2-5 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? Has this deduction been r� 'S state amount of
other county on property for �f i
in Indiana? ❑ Yes 0 No current year? ET Yes El
C El No
. �R
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 A20 20 20 20
Sign e County Audito County Date(month,day,year)
k. ,,7-f . 1 .1 So -i , Le.L5_ u
\Q1/W certify under, en Ity.of perjury th the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
w r/contract buye ,of the aforeme i ned property on date application is filed.
nature(owner's full;am�X ,day,yeah
/�ttl��"UV��e V a 1 P3I2020
resident address of applicant(number and street,city,state,and ZIP code) Date month
503 W Elm St., Haubstadt, IN 47639
Person authorized by duly executed Power of Attomey 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.
i