HomeMy WebLinkAboutMortgage_Schaer STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
° _ FOR DEDUCTION FROM ASSESSED VALUATION
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v`t.f+ State Form 43709(R13/10 15)
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Prescribed by Department of Local Government Fina e
INSTRUCTIONS: ehlt V'\�' File Mark
To be filed in person or by mail. F rm r ed with:
Filing Dates: 1) Real Property:Must be c mpleted And dated i th alendar year for which the deduction is sought.
Must be filed or postmarked with the County Au r or County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
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)
Christopher P. Schaefer and Reyna A Schaefer, husband and wife
Taxing District Key number/legal description Record number Page number
Union . 26-19-19-300-002.213-025 NOr2() 114-) �
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
assessment date,current year assessment date,current year date of application legal or equitable owner?
$116 ,000.00 E] 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
M Real Property U Annually Assessed
a T..ile Home(IC 6-1.1-7)
Name of mortgagee or contract seller I
Old National Bank JJ
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
One Main Street. Evansville. IN 47708 DEC 16 2020
Name of assignee or other owner or holder of mortgage !(�
Address of assignee(number and street,city,state,and ZIP code) �9M�
GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti een requested If yes,state amount of deduction
other county on property for i
in Indiana? ❑Yes ®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 on ct 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
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Signature of County Auditor trill*
County l Date(month,day,year)
. Q1,1\
1/We certify under the penalty of perjury th• - :•• e and foregoing information is tru d correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig Lire(owner'full ame) Date(month,day,year)
v , /JX �_ �r �� _� (� -/3- Z o ZrG
Full resident address of appli t(number and street,city,state,and ZiP code)
8253 S US Hwy 41,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 include imprisonment up to two and a half years and a tine not to exceed$10,000.