HomeMy WebLinkAboutMortgage_Davis (14) tt-T'tze. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS -County Township Year
a' --_ FOR DEDUCTION FROM ASSESSED VALUATION Gibson OZg 2020
�' _ / State Form 43709(R14/1-20)
1®, `� Prescribed by Department of Local
u County Auditor
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 calendar year in which the property taxes are first due and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) •
Leigh Ann Davis •
Taxing District Key number/legal description Re ord number Page number
Princeton 26-12-06-304-001.307-028 and CHAS BROWNLEE 4 PT/5 X� fial)
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?
$0.00 $102,900.00 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: Isstt e property in question:Annually Assessed
Real Pr??.:, 0 Annually Assessed
obile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank zf
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
PO Box 918, Evansville, IN 47706 00-22
Name of assignee or other owner or holder of mortgage �O�
Address of assignee(number and street,city,state,and ZIP code) G/8S0 i O
Cot�N
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested 1')If �state amount of deduction
other county El No on property for El Yes ❑ NO OAT
in Indiana? current year? OR
A person is not entitled o 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
Signat e f County Auditor 1 ‘ County Date(month,day,year)
Gibson .
I/We certify under penalty of perjury that the abov nd fo oing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si ature ow ei's full"riaiie) �""'---+ .k Date(month,day,year)
�J �iL/I2���1�sc.-17
10/05/2020
Full resident dressbf applicant(number and street,city,state,and ZIP code)
923 N Main St, Princeton IN 47670
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)
Tho nAnalfies for cerium can include imprisonment up to two and a half years and a fine not to exceed$10 000.