HomeMy WebLinkAboutMortgage_Leek OE STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.t ,. FOR DEDUCTION FROM ASSESSED VALUATION
,'1%..� ; State Form 43709(RI1 6-09) Gibson Haubstadt 2021
��'«-<<?• Prescribed by Department of Local Government Finance RECEIVED�eie em
INSTRUCTIONS: Io-ii l JAN 12 2021 File Mark
To be filed in person or by mail.
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. Form filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. County Auditor
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of the ❑ County Recorder
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)
* Curtis J.Leek and Amanda O.Leek
TaxingDistrict Keynumber/legal descri tiorL,r ,p ? ,' .. _y� J Record number Pag@.,number
* oO� * PT SE 36-31 1 .38 AC 4-b"� O�J�' 'O`'i—0001S fl fps
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
* $0.00 * $0.00 *-Wert,- / /0//aic,vD ❑x Yes 0 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
0 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ILE jJ
* Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
* PO Box 918,Evansville, IN 47706 JAN 1 2 2021
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street, city,state,and ZIP code) '2 .L`!',-.y..: .:41
GIBSON COUNT' ,,lr®i
Does applicant own property in any other In yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
0 Yes ❑ No X Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor. I I,qCitt" County Date( o h, day,year)
' j SOS L- ` 4:i2\
I/We certify under the penalty of perjury that th0:- _:•ve and foregoing information is r e and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date a lication is filed.
sign ne ' name) )? 0 LK Dctei(tmo� I G(�gth,�day, e1r)
Full resident address of applicant(number and street, city,state,and ZIP code)
* 521 W SR 68,Haubstadt,IN 47639
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)
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant G C (An OA r eeit ' Name of mortgagee p{contOct s ler(6 l_
Date filed(month,day,year) Amount of indebtedness r Id 1 Taxing District F
(- IZ-�fu L 0�) aoa _
Key number/le I descriptio I sl
' �-1�_ 3�--4014- ooO , 3FM ' ',�� Zo2‘ -C3 el
Signature of County�y diito�C ntq Recor ou t,for Date month, day,year)
1� J4'n I. 11-.10021 . .‹
JAN 12 2021St '
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Statement of Mortgage or Contract Indebtedness GIBSON Uv i,!Y PTO•. IN2019419