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HomeMy WebLinkAboutMortgage_Beard a0,-,— STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION ii )$` v State Form 43709(R14/1-20) RECEIVED Gibson ©M 7 00 �°�-Y `= r' Prescribed by Department of Local Government Finance INSTRUCTIONS: To be filed in person or by mail. DEC 2.12020 File Mark Form filed with: Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. izi 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 ich the pr e y taxes are first due and payable. ❑ County Recorder • See reverse side for additional instructions and qualifications. V p Cu l 14 I Applicant(owner or contract buyer-see restrictions on reverse side) Victor Dean Beard Taxing District Key number/legal description Rgsprd numb_er_ P�e nunzr� Princeton 26-11-12-102-001.603-028 'lJ/O r(l��`l' L !/` Assessed value of real property as of Mortgage i Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican the sole assessment date,current year assessment date,current year date of application legal or equitable owner? $142,000.00 0 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: " ii he property in question:Annually Assessed Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Old National Bank DEC 21 Z020 Address of mortgagee or contract seller(number and street,city,state,and ZiP code) One Main Street, Evansville, IN 47708 Name of assignee or other owner or holder of mortgage - :`r/ • GIBSON COUNTY AUDITOR Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has this deduction en requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes ®No current year? Yes 0 No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c nt 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 0r 20 20 20 20 20 � 1 Signature of County Auditor A County 1 Date(month, y,year ' i.Mr 1,We certify under th- •enalty of perjury th e and foregoing information is titre nd correct and that the applicant is a esident f Indiana and owner/contract buyer of the aforementioned property on date application is filed. Si natu es(or /Qouta u '-+J` Date(month,day,year) 12/16/2020 Full resident address of applicant(number and street,city,state,and ZIP code) 308 N Third Ave., Princeton, In 47670 Person authorized by duly executed Power of Attomey 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 oeriury caninclude imprisonment up to two and a half years and a fine not to exceed S10.000_