HomeMy WebLinkAboutMortgage_Nelson (9) �ER,4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
4, • FOR DEDUCTION FROM ASSESSED VALUATION Year
State Form 43709(R14/1-20) Gibson 017 2021
eu Prescribed by Department of Local Government Finance
toll
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Simpli file/Patti/away T . . .2/23/2021 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. ® County Auditor
Must be fried 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. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Taxing District Key number/legal description Record number Page number
Washington 26-06-19-101-000.757-017 7-'C2\� c3g
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the srole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$117,000.00 1Yes ❑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
®Real Property ['Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Springs Valley Bank &Trust Company F I LED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1500 Main St., Jasper, IN 47546 Feb 23 2021
Name of assignee or other owner or holder of mortgage y&ka a .f/61 to
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUDITOR CB
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 propertyfor
in Indiana? ❑Yes ®No current yer? )(Yes 0 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 amount of:
20 20 20 20 20 20 20
Signature of County Auditor CB County GSOn Date(month,day,year)
j�a 2/23/2021
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signs r ers / a e) L Date(month,day,year)
���,i 02/22/2021
II I resid
e address of applicant(number and street,city,state d ZIP code)
l/
5975 E 390 N, Francisco, IN 47649
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
Geoffrey M. Nelson and Stacy M. Nelson Springs Valley Bank & Trust Company
Date filed(month,day,year) Amount of indebtedness Taxing District
2/23/2021 $117,000.00 FILE'vashington
Key number/legal description
26-06-19-101-000.757-017 CR jFeb 23 2021��
Signature of County Auditor/County Recorder 7a CG son lr, cc�1de?G.� JPQ) I Date(month,day,year)
a yYL
GIBSON COUNTY AUDITOR CB 2/23/2021