HomeMy WebLinkAboutMortgage_Evans (4) f—ti: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship`'. 'a FOR DEDUCTION FROM ASSESSED VALUATION Year
F4 + State Form 43709(R14/1-20) Gibson O 2020
N leis� Prescribed by Department of Local Government Finance RECER;y_Ijj
INSTRUCTIONS:To be filed in person or by mail. I jiA File Mark
'wl �.Se�,�:.� JAN 0 5 2021 Form fil with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property County Auditor
is 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)
RICHARD E.EVANS
Taxing District Key number/legal description Record number Page number
26-05-34-200-004.522-027 <l iED L. CO 17.0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
161,889.00 „,•,1'es ❑ 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 th property in question:Annually Assessed
t Real Property ❑ Annually Assessed
FILED Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
UNION HOME MORTGAGE CORP y
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) JAN
At O ;� 9oz
8241 Dow Circle,West,Strongsville,OH 44136 (�►IV NIL L�l
Name of assignee or other owner or holder of mortgage
i/I/1 q '
a. .4,7,,,e,,/W/
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 deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes No current year? ❑
III '® Yes ❑No
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 anrunt of:
20 20 20_ 20 20 20 20
Signature of County Auditor Wi W 4;3County \ Datel(month,day,year)
l.� C sod 202,
I I We certify under the penalty of perjury that the above and-foregoing information is tru nd correct and that the applicant is a resident of Indiana and
owner/contra buyer of the aforementioned property on date application is filed.
gr.
n ' e) Date(month,day,year)
�` December 22,2020
Full resident address of applicant(number and street,city,state,and ZIP code)
•
2237 N 350 E,Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
December 22,2020
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$10,000.
RECEIPT FOR FILINFA NT O} t. GE OR CONTRACT INDEBTEDNESS
Name of applicant l;•-e of mortgagee or c ntract seller
RICHARD E.EVANS I 1(7� I. I ri— 1e' �J
Date filed(month,day, earl 2\ Amount Jf'1�b osZOZ Taxing District .) T> Ii 7
). .'r • 161,8;9.00 Q�� • o 0
Key number/legal description AG'./ .te a, eG�+P,r �`� ^ 61 1 `� • ry
26-05-34-200-004.522-027 c a
IBSO Y AU ITOR y-
mi
Signature of County Auditor I County Recor¢$r� I County � _^ Date(month, ,year "
1/u\"IVAvI � r 1 I - � 1