HomeMy WebLinkAboutMortgage_Reyes �, �4k, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS - County Township Year
An' ` `y FOR DEDUCTION FROM ASSESSED VALUATION
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� yt j �;:;: State Form 43709(R14/1-20) _ Gibson Patoka 2021
-�� Prescribed byDepartment of Local Government Finance l 4 rkiED
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INSTRUCTIONS: To be filed in person or by mail. 1l6f.A.' 1 , C ',
�'� J ^1•I File Mark
Form filedwith:
Filing Date: Form must be completed and dated in the calendar year for which the deduction islsought. 17t�County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is J"
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)
Juan Alberto Reyes
Taxing District Key number/legal description Record number Page number
028 26-12-18-202-000.142-028/SS Add 341, Gibson County a 090 -tom p Si (ps
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 applicatigq so legal.r e. ,itable owner?
n 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: - Is the property in question:Annually Assessed
eal Property ❑AMnnuobile Hally oAsseme(IC ssed
I ', 6-1.1 7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
PO Box 918, Evansville, IN 47706 NOV a 8 2020
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUDITOR
Does applicant own property,in any If yes,what county? What Taxing District? Has this deductio ben requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes ❑No
A person is not entitled o thi eduction unless the person has a balance on the person's mortgage or ontract 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 1 Date(mo th,day,tyear)
i ft t ,50 n \\ vg (\co. .
I,We certify under the penal y of perjury that the-::••_ - .foregoing information is tru and correct and that the applicant i d resint of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. - ___ _ _ ____ _—
Sign (owner' ame) - --r Date(month,day,year)
/ / \ —10—30
II resident address of applicant( um street,city,state,and ZIP code)
1008 South Stormont Street, 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortga ee or contras seller
(1\Q
Date filed(month,d y,year Amount of indebtedne 1 Taxing District d
1\,VS -ORo ^ d a �,�
Key number 1 legal description _ r i
aco - la - e i -'�o -cc 14 a_ r o g 8,2020 2 0 20 -- 5� C-S- c` .
Signature of uditor/CouCj
nty Re County \ Date(month,day,yea_ r) r D I
i-Ain
GIBSON COUN AUDITOR