Loading...
HomeMy WebLinkAboutMortgage_Lewis (17) �,, _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION Gibson A.',_•Fe..,.... 2021 �� State Form 43709(R14/1-20) Prescribed by Department of Local Government Finance File Mark INSTRUCTIONS: To be filed in person or by mail 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 filed or postmarked with the County Auditor or County Recorder of the county where the property CountyRecorder is located on or before January 5 of the calendar year in which the property taxes are first due and payable. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see resbfctfons on reverse side) Anthony Lewis Taxing District Key number/legal description Record nnumberP page number QL a Fort Branch 26-18-13-402-000.725-026 I SYMONDS ENLG 205 PT a( L-1.--1 Assessed value of real property as of Mortgage/Contrast indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Isg i applicant or ttthe R assessment date,current year assessment date,current year date of application ,oreq• $0.00 $80,514.00 ;ilea 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 ih roperty in question:Annually Assessed Real Property 0 Annually Assessed Mobile Home(IC 6-1,1-7) Name of mortgagee or contract seller Mortgage Masters of Indiana,Inc. Address of mortgagee or contract seller(number and street cry state,and ZIP code) 501 N.Cross Pointe Blvd.,Evansville.IN 47715 Name of assignee or other owner or holder of mortgage Address of assignee(number and street,oily,state,and ZIP code) Does applicant own property In any If yes,what county? What Taxing District? Has this deduction n requested If yes,state amount of deduction Othercountyon property for es 0 No Indiana? El Yes 0 No current yeah A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ntra 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 offi that I he basis for the deduction. COUNTY AUDITOR Deduction approved In the amount of 20 20 20 20 20 20 20 - Signature of County Auditor /i ` •�,, a`' _- County Date(moth.day,r year) (,��"\ .. C _ Q (% •W 0...7' _a.J"4 f�'t�]�'�''`)� Gibson I —3-,D n Q - y- I/We certify Lun`d-eerr-penalty of perjury that the above and foregolny n formation 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. �gnata (ot r'e.,, mad ( 3:2021 �- 't. e l 1 ew,'� F 11 resident address of applicant(number and sheet,Oily,state,and ZIP code) 300 N.West St,Fort Branch,IN 47648 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 end 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 Anthony Lewis Mortgage Masters of Indiana,Inc. Date riled(month,day,year) Amount of indebtedness Tatting District t�^ . V".-% ._70� $80,514.00 4-. ' S t" Key number/legal description 26-18-13-402-000.725-026/SYMONDS ENLG 205 PT Da f onm,day,yea signature of county Auditor/ nri`Re °^ �. County t 'a 6 ' \, r,. W(?-� „t„.Y�� etc 1 Gibson FILED JAN 0 3 2022�-. ' `!12so44u- GG. aim r r .%r1a) GIBBON COUNTY AUDITOR