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HomeMy WebLinkAboutMortgage_Rogier Ojrcif*---,,i. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I'°' FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R11 6-09) c Gibson Haubstadt 2021 Prescribed by Department of Local Government Finance pp���� C`C"1 0 2021 File Mark INSTRUCTIONS: A e-y'lrf '` 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. 0 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) ��p© * Marty L.Roqier Taxing District '0O Key number/legal description . '‘ —a�j-"6 ti-'ZOO —c C' *7 Recor noui µgi`r Pa be `J� J'� *ALTE DEUTSCHE STADT 2 PtUNIT 1 c- 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 *$142,405.00 lI Yes El No If no,what is his/her exact share o ILE ■ ) If owned with someone other than spouse,indicate with whom If name on record is different than th f licant,indicate below: Is the property in question: Annually Assessed DEC 0 9 ZOZ1 0 Real Property 0 Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller * First Federal Savings Bank �,, .+li R� Address of mortgagee or contract se $TtieW&? 2tate,and ZIP code) * PO Box 1111,Evansville, IN 47 Name of assignee or other owner or holder of mortgage Address of assignee(number and street, city, state,and ZIP code) Does applicant own property in any other In yes,what county? What Taxing District? Has this deduction been re..t sted on property county in Indiana? for current year? 0 Yes No = Yes 0 No COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 ,I 20 2 0 20 Signature of County Auditor in‘_ .. — {� _ Count C Data mot da ear) I/We certify under the penalty of perjury that the above foregoing information i$tie and correct and that the applicant is resid nt of Indiana and owner/contract bu the aforementioned property on date application is filed. Signa is ful a Date(month,day,year) 12/01/2021 Full reside dress of a lican umber and street, city, state, and ZIP code) * 521 S. Eighth Ave,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)