HomeMy WebLinkAboutMortgage_Chumbley :g"-.'f . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i'r FOR DEDUCTION FROM ASSESSED VALUATION
+r`; Gibson 0Z9-- 2020
�:'f•. •', State Form 43709(R14/1-20) • E r 1 •
,e a Prescribed by Department of Local Government Finance
INSTRUCTIONS: To be filed inperson ormail. I,OSS� 1 OCT ���� File Mark
by Formrf filed with:
Filing Date: Form must be.completed.and dated in the calendar year for which the deduction is sought. 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)
• Elizabeth C. Chumbley and Joshua A. Chumbley
Taxing District Key number/legal description Record number Page number
02:— . 26-11-15-100-000.569-027/PT E NW 15 2 11 5.01 AC D-17 20 L)4._3 2
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 eigt7b e owner?
$118,750.00 ILLY�s ❑ 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 pr..-rty in question:Annually Assessed
I T F. 7 - val Property 0 AMobnnuallyilHome Assessed
„ e (IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and.ZIP code) OCT 2 8 2020
501 N. Cross Pointe Blvd., Evansville, IN 47715
Name of assignee or other owner or holder of mortgage • -i. -----
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY huDiTOR
Does applicant own yroperty in any If yes,what county? What Taxing District? Has this deduction b n requested If yes,state amount of deduction
other county tid T es ❑ No yy�� "yr /F on property for Yes 0 No
in Indiana? v� �G �p � 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 Audi 4 , ( County Date(month,day,year)
1ifl " " Gibson )0 • 2F •`20e—R)
I/We certify under penalty of perjury that the above and foregoing 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.
Signature owrber's full name ate(month,day,year)
73tsiCrs21 a�dr5ss of�pplicant(nug]t/�(`and s, et,city, V/ r q - (0��
Person authorized by duly executed Powerer of Attorneyor or by IC 6-1.1-12-0.7 1 (// ) Date(month,day,year)
Address of authorized person(number and street,city,state,and ZIP code)
The penalties for periury can include imnrisonmer.to two and a half years and a fine not to exceed$10,000.