HomeMy WebLinkAboutMortgage_Harvey (6)..
I I ,
' ,-07.1*-4:, -•,:t , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
IA-41A FOR DEDUCTION FROM ASSESSED VALUATION
, . . .
State Form 43709(R14/1-20) : N Gibson
''.'"-----.----, Prescribed by Department of Local Government Finance 0 2,\ 2021
2021 File Mark
INSTRUCTIONS:To be filed in person or by mail. lwve_ -1- --Ci,rv-% Form led with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property County Auditor
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)
CALEB CHARLES HARVEY and TIFFANY HARVEY
Taxing District Key number/legal description Record number Pte rkuSers___
./11001.0001 26-17-32-200-003.524-021 .30 2-\
Assessed*Attie of real roperty as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,curre t year assessment date,current year date of application legal or ecmyielee owner?
230,000.00 Yes 1] 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:
FILED ls:tzroperty in question:Annually Assessed
eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
THE FIRST NATIONAL BANK OF CARMI JAN 0 5 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
201 E.Main Street,P.O.Box 70,Carmi,IL 62821
tA4e..124E1-e . ..i'f' .:,,.......--J
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in a If yes,what county? What Taxing District? Has this de cti n b en requested If yes,state amount of deduction
other county on property or
in Indiana? 0 Yes No current ye ? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortga or c act 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 ffice) ha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20
I 1 20 20 20 20
Signature of County Aud(Or0001-\k.(VS CCO Date
CoA,„..s 0 v..\
I/We certify under the penalty of perjury that the above—and foregoing informatio i true and correct and that the applican is a resident of Indiana and
owner/contract buyer of the aforementione property on date a.pli ation is filed.
e(?,ner's full name) I Date(month,day,year)
Signal
1 I - November 15,2021
Full resident address of ap c ber and street,cit, -.and i
can
(num • code)
10676 W 1000 S,Poseyville,IN 47633-9646
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 1 Date(month,day,year)
November 15,2021
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.
RECEIPT FOR FILING STATEMENT OF MORTGA NOR,CONTRACT INDEBTEDNESS
Lr,
Name of applicant r o njo. rtgagrloaracl_71,zrk
CALEB CHARLES HARVEY and TIFFANY HARVEY F1 C-• :
----
Date filed(montlyay,ca..r) Amount of indebtednes ....L._._,_,0 Taxing Dis oct• t ,
u2__A CT,
r--.,
Key number/legal description 230,000.00z
JAN 0 5 26 2 — r-..., .
26-17-32-200-003.524-021 AID--•.• (X) 3
Signature of County Auditor/County Re •rder . Date(month.day,year)
‘4-1.,S, '-. •ON COUNT - :,.' :' 3.CD i.
.6.41 ,,,..f • ' ....
"IIIIM."
. .