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HomeMy WebLinkAboutMortgage_Rogers (2) An'*t-,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year a. = FOR DEDUCTION FROM ASSESSED VALUATION «; Gibson 00C 2021 i State Form 43709(R14/1-20) ;ere' Prescribed by Department of Local Government Finance RECEIVED � File Mark INSTRUCTIONS: To be filed in person or by mail. 18O,S)L" 1' FEB 1 8 2021 Formrr filed with: I� Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. I 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 which the property taxes are first due and payable. 0 County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Chrysanne M. Rogers Taxing District Key number/legal description Record number Page number U©k . 26-18-36-403-000.431-009/WEST HGTS 2ND ADD 114 A 9-0 21 I Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year assessment date,current year date of application legal or equitab owner? $170,000.00 es 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 U-al Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Old National Bank FILE Address of mortgagee or contract seller(number and street,city,state,and ZIP code) PO Box 918,Evansville,IN 47706 2021 Name of assignee or other owner or holder of mortgage FEB •. Address of assignee(number and street,city,state,and ZIP code) I��J„ _t. a.,!/Y� .,��n1�r�11��t A�UNTY AUDITOR Does applicant own property in any If yes,what county? What Taxing District? wes-thARli�c1iion be equested If yes,state amount of deduction other county on property for Yes 0 No in Indiana? El Yes I�NO current year 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 amount of: , • 20 20 20 20 20 20 20 Signature of County Auditor County Date(moot ,da ,year) m Gibson 2. 1a- r O2-1 I/We certify under penalty of perjury tha above and foregoing information is true and correct and that the applicant is a resi ent of Indiana and owner 1 contract buyer of the aforementioned property on date application is filed. Si ure(owner's full na e) Date s - (monntth,day,year) O'o2L Fu resident address of applica t(number and street,city,state,and ZIP code) 114 S.Vonna Lane, 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) ... - ------•- •-- • ..._1_...._ ...,,.I,nIF., ...e.....d n F.,.n.,.,f f„o,,,.aaa c/o nnn