HomeMy WebLinkAboutMortgage_Hart (6) i•* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I To nship Year 74' ` �, FOR DEDUCTION FROM ASSESSED VALUATION
�,�`�al` Gibson OC 2021
State Form 43709(R14/1-20)
��sta-1'; Prescribed by Department of Local Government Finance
ItC.; , File Mark
INSTRUCTIONS:To be filed in person or by mail.r\ .Q 1 ' S J! Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. Gounty 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)
JUSTIN W.HART
Keynumber/legal description cord ny{nb r Pee!rp�egr
Taxing District C/.`-- t--{\`1�_
Oa�i t nd 6 26-14-18-203-000.867-007
Assessed value of real proprrty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is theapeplicaant tee sole
assessment date,current year assessment date,current year date of application legal o
142,373.00 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
Is t property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: Real Property ❑ Annually Assessed
111777"' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ED
MORTGAGE MASTERS OF INDIANA,INC.
Address of mortgagee or contract seller(number and street,city,state,and ZIP c e)
501 N Cross Pointe Blvd,Evansville,IN 47715 A' 5 2022
Name of assignee or other owner or holder of mortgage JpN a
Address of assignee(number and street.city,state,and ZIP code) / ;. ,yr�UD,T
N leg
G. NTY A
CC�� Has this deducti been requested If yes,state amount of deduction
goes applicant own property in ny If yes,what county? What TaxingQ dt? on property for
otherd county current year? Yes ❑No
in Indiana? [I]Yes Na
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o co tract 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)t at is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20
20 20 20 20 20 20
County k T Date( on ^ar_L
Signature of Cgtiryy ud' -.` �,/'� � v v`rJ5 \I/We certify under the penalty of perjury that the above and foregoing information ind correct and that the applica t is a sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. Date(month,day,year)
Signa re(owner's full name)
)1
,V _ November 30,2021
/F�]{I resident address of7a-pplica applicant(number'-
and street,city,state,and ZIP code)
( 619 North Polk St,Oakland City,IN 47660 Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 November 30,2021
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.
lecCor
EIPT FOR FILING ST-pIyI NT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant u � �m °rtgr,: °r a� et seller(,
JUSTIN W.HART 1' s °``�• �p'U,1�J�, .-}\—'F✓ s.', c,�
Amount of indebtedness I Taxing Dis_trict� t
Date filed(month, ay,yam.- 1-' U U c__f
\J JAN 4'3�'2P /�,.,
Key number/legal escription 2Q 2,..\ - V )O 6 c..
26-14-18-203-000.867-007 +�� '�F Date(m h,day,year) r�
Signature of County Auditor/Co my S r County y \ �� � - .. -j`,V`tGIBSON COUI�,fTV,,L.::; , \