HomeMy WebLinkAboutMortgage_LLC (7) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Townsh Year
FOR DEDUCTION FROM ASSESSED VALUATION 'L.4 L021
r. 1; Gib ®son Pste ,, -
State Form 43709(R14/1-20) RECEIVED
.' "tl' Prescribed by Department of Local Government Finance
`� T DEC 1 5 2021 File Mark
INSTRUCTIONS: To be filed in person or by mail. t\� orm filed with:
Filing Date: Form must be completed and dated in the calendivyear for which the deduction is sought_ A County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propert =�
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)
Allen's LLC � Q Keynumber/legal description r_R�.H.c,ord number P/aage numb
Taxing District 0 �--Z� F"��-r 21 4, �O
Pam--'' 26-12-07-104-001.986-028/Pt Lt 48 Original Plan !F!!'"'��`^����-//�� l VVV
''Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is thapplic able owner?t the
assessment date,current year assessment date,current year date of application legal or qeS 0 No
$152,900.00 $125,000.00 and$100,000.00 .„
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
F 1-I- F D Real Property 0 AnnuallyMobileHome Assessed(IC 6-1.1-7)
I /
Name of mortgagee or contract seller
Old National Bank, ISAOA/ATIMA (� �`-; �}��j�
Address of mortgagee or contract seller(number and street,city,state,and ZIP cooDEC 22O2 t
PO Box 918,Evansville, IN 47706 �-�j,, ) ��
Name of assignee or other owner or holder of mortgage / --.4.QGt! a .YYQ ,E.vrztt)
GIRSON.COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deducti en requested If yes,state amount of deduction
other county on property for Yes 0 No
in Indiana? ❑Yes NO current year?
A person is not entitled t this deduction unless the person has a balance on the person's mortgage or c nt 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 i he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
CJ � 25
Signature of County Auditor J Countyt2 21
Gibs
on Date( b d ear)
I,We certify under penalty of perjury that the above an regoing information is true and correct and that the applicant is a resi ent of diana and
owner/contract buyer of the aforementioned property on dateapplication is filed. �y
E a �/', I Date(m ontfr_i Y r)
Signature(owner's funame) L t.c/�t/
. 54V
Full resident address of applicant(number and street,city,state,and ZIP code)
218 W State Street, Princeton, IN 47670 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person(number and street,city,state,and ZIP code)
The nannteoe far or;,,,,, s„;„,00-4e:.. -0-i0.,arnsa.,t ern/n two,and a half years and a fine not to exceed S10,000.