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t7 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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��a '- _ FOR DEDUCTION FROM ASSESSED VALUATION • Gibson -Union- � 2020
State Form 43709(R13/10-15) RECEIVED
-4.F Prescribed by Department of Local Government Finance
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2 2�20 N' 1File Mark
INSTRUCTIONS: R..
I Form filed with:
To be filed in person or by mail. A
Filing Dates:1)Real Property: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 ❑ County Recorder
property is located on or before January 5 of the immediately succeeding calendar year.
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)
Matthew T.Johnson , Molly Johnson
Taxing District Key number/legal description Record number Page nubpr
41410 - d 2 26-19-19-101-000.618-026 i `?O?^O 501
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 or equitable owner?
$76,800.00 75,150.00 mYes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wh
I
If name on record is different than that of applicant,indicate below: he property in question:Annually Assessed
l Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller , !I�
Old National Bank FIT d; 'R-,I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) -
PO Box 918, Evansville, IN 47706 NOV2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) .r (p.�-,-.,i
•
IBSON COUNTY %WF?iTOR
Does applicant own property in ny If yes,what county? What Taxing District? Has this deduction be requested If yes,state amount of deduction
other county on property for
in Indiana? 0 Yes NI No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ntract 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 � 1o\ AdtrCounty \ Date
1(month,day,year)
YC\
I/We certify under the penalty of perjury that t - -•ove and foregoing information is true`dnd correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
7e(ow full nai Date(month,day,year)
�/�,/ ill 10/30/20
Full resident address of applicant(number and street,city,state,and ZIP o )
600 S Center St, Fort Branch, IN, 47648
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 inni.,rin i^- ' mnnr tin to hnin and a half years and a fine not to exceed$10,000. 46562