HomeMy WebLinkAboutMortgage_Baker (7) „• �*•,,, STATEMENT OF MORTGAGE OR CONTRACT INDEETEDNESS County Township Year
,ja FOR DEDUCTION FROM ASSESSED VALUATION
,,,- f; State Form 43709(R14/1-20) Gibson OZ'S �Zi
• �_.� FEB 0 1 2021
”' - �-' ' Prescribed by Department of Local Government Finanrt
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D-�-C TFile Mark
lNSTRUCT/ONS: To be acted in person or by mail �(J�J�� Form riled with:
Filing Date: Form must be completed and dated in the calendar year for which the deductio i sought: El County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the c my where the property 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)
Brian J. Baker and Jamie S. Baker, husband and wife
Taxing District Key number/legal description Record number Page nu r
Princeton 26-12-06-402-004.326-028 ),C3 1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant role
sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$177,000.00 glYes ❑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: operty in question:Annually Assessed
1 - ,I Property CIAnnually Assessed
+i Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller A
Old National Bank 1.,,,, f;, �++Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �C;L\
One Main St., Evansville, IN 47708 p{�,�"o� ®\
\ lit
Name of assignee or other owner or holder of mortgage q�• �®
ON
Address of assignee(number and street,city,state,and ZIP code) r„A' Jk�1
Does applicant own property in any If yes,what county? What Taxing District? Has this ion een requested If yes,state amount of deduction
other couty ❑Yes ®NO Yes ❑No on prope for
in Indiana? current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ont t 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 Col A Ho CountyDares r"^1 n, day, NO
g � ��^ So° (J/�J�}� Ql
I/We certify under the penalty of perjuryCe and foregoing information ile and correct and that the applicant be real ent of Indiana and
owner/contract aforementioned property on date application is filed. ,
Signature weer full name) . 7 Date(month,day,year)
i` 01/27/2021
Full teaid nt a d ss of a mber and street,ci ,sae,and ZIP code)
1519 Willowbrook Dr., Princeton, I 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 mortgagee or contract seller
Brian J. Baker and Jamie S. Baker Idelat
Date filed(month,day, ea Amount of indebtedness i I, ,' Taxing District T 70
`Z- 1r2� si 0 .00AA . Princeton
Key number!legal description C.
26-12-06-402-004.326-028 '- o i ? • ��
Signature o Coun`tyy�ditor I unty Reco r County Date(month, ay,y ar) o ;
WQ G'son 490400) 2 - 2