HomeMy WebLinkAboutMortgage_Andis ^-- -STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE —
Co�tnty Township Year
Yd 'r�_R�; FOR DEDUCTION FROM ASSESSED VALUATION
RECEIVED
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t ....<. 1, State Form 43709(R13/10-15) �t� V
,616 Prescribed by Department of Local Government Finance
INSTRUCTIONS: .3 /Oc&d&AJc&A 2-0
JUL 15 2019 File Mark
To be filed in person orbymail. Form filed with:
Filing Dates: 1) Real Property:Must bd completed and dat d'n the calendar year for which the deduction is sought.
Must be filed or postmarked with the Coun uditor or County Recorder of the county where the property is RI County Auditor
located on or before January 5 of the immediately succeeding calendar year. t 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)
M. Shane Andis and Tracey E. Andis, husband and wife
Taxing District Key number/legal description Record number Page numb
Center (DO4. 26-13-20-200-000.303-004 2020 ZCt 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 legal or equitable owner?
• $131,250.00 E Yes LI 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
roperty ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
FILV,
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) JUL 2 2 2020
One Main Street, Evansville, IN 47708
Name of assignee or other owner or holder of mortgage
43.40,44
Address of assignee(number and street,city,state,and ZIP code) 4IssQN COUNTY AUDITOR
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? ❑El 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 20
Signature of County Auditor 5 County \ Date(mo h,day, ar) r�
1\61-3?V\ C\)1 so i 2-2• , 2V to
I/We certify under the pen y of perjury that the -:ove and foregoing information is true n correct and that the applicant i a resi ent of Indiana arid
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full na Date(month,day,year)
/, � 07/08/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
1949 S Lakewood Cir, Francisco, IN 47649
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.