HomeMy WebLinkAboutMortgage_Robbins (3) rT� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �,[/
��"1'�'-'C r State Form 43709(R14!1-20) �� Gibson
.', `';'' Prescribed by Department of Local Government Finance /CL" ��
INSTRUCTIONS: To be filed in person or by mail. 1\1 Pi 1 r }CC24
��?O9 File Mark
lAY-A `, Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. m 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. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Matt Robbins and Tara Robbins, husband and wife
Taxing District Key number/legal description Record number Page number
Patoka \to,)� iV 26-05-40-188-004.117-027 Z\
Assessed value of real p perty 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 equitable owner?
$326,650.00 FJYes ❑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 D Annually Assessed
Name of mortgagee or contract seller .. • _ y'- Mobile Home(IC 6-1.1-7)
The First National Bank of Carmi
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 2021
201 E Main St., Carmi, IL 62821 FEB 2 5
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) 11 /Ged
UNTY AUDITOR
GIBSON CO
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction b requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ®No current year? Yes [-a]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 County 1 Date(month,day,year)
In tiOC JS c� sc Z• 2)'- 'LA 2,
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.
S' natur (owner's full name) Date(month,day,year)
_ — <_ 02/24/2021
Full resident address of applicant(number and street,city,state,and ZIP code)
2500 N Tower LN, Princeton, IN 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)
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Matthew Robbins and Tara RobbiF The First National Bank of Carmi
Date filed(month,day,year) i eta..t. ,. ' Taxing District
2.2c 1(31 _ . $326,650.00 Patoka \�A,s e
Key number/legal description EB 2 5 10Z 1 - .
26-05-40-188-004.117-027 074 — cRD -
Signature of County Auditor/ t Recorder • County Date(month,day,year)
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