HomeMy WebLinkAboutMortgage_Ambrose (2) 4g A'k' . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r. -,y FOR DEDUCTION FROM ASSESSED VALUATION • Gibson 2020
+oi State Form 43709(R14/1-20) p \ ®Z4 .
lore Prescribed by Department of Local Government Finance 1•�'� IP(N
�) /`� _ n^ a�� File Mark
INSTRUCTIONS: To be filed in person or by mail. 3 1 `'�' 2 w up,se�j� �`�� Form filed with:
Filing Date: Form 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 pro. ,,
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. County Recorder
See reverse side for additional instructions and qualifications. -
Applicant(owner or contract buyer-see restrictions on reverse side)
Matthew Ambrose and Hollie Ambrose
Taxing District Key number/legal description Record nu er Pagg nyfnl?er _
Haubstadt 26-22-15-300-002.699-024/PT NW 15 4 11 10.521 AC 2O? L�,��j
o 4
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applica the sole
assessment date,current year assessment date,current year date of application legal or e able owner?
$0.00 $190,500.00 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indi to with whom
If name on record is different than that of applicant,indicate below: Is th roperty in question:Annually Assessed•
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /
Indiana Members Credit Union r` - ..A -1
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �
320 Eagle Crest Blvd., Suite E, Evansville, IN 47715 SEP �i 5 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) r1e �I./-�
ihd�Y II��hL�� j.�� ����tt RR
Does applicant own property in a y If yes,what county? What Taxing District? Has this dedudali� l I1 Itbg6L';3tItP9rfiount of deduction
other county ❑ Yes ❑ o on property for ❑Yes ❑ No
in Indiana? current year?
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 County Date onth,d y,year)
c-111\. 6) Gibson Q 2 f20-u)
I,We certify under penal of perjury that the above and foregoing information is true and correct and that the applicant is a re ident o Indiana and
owner I cont act buyer of the aforementio d property on date application is filed.
Si ure o er's f II me) Date(month,day year)
°1adV1.164 a ,l
Full res' ent address icy ant m er and street,city,'state,and ZIP code) 7
12489 S.Owensville Rd., Haubstadt, IN 47639 •
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$1Q.Dnn