HomeMy WebLinkAboutMortgage_Everett (2) M f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ounty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION SOn 0 24 Z
N State Form 43709(R13/10-15) J
":o_. .�' Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: Form filed with:
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. County 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 immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 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)
Everett, Chad A. & Shelly A. Resprd number Page number
Taxing District I Key number/legal description ;,,t n b '
Princeton 26-12-18-202-002.853-028 (/�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 11s the or the sole
date, legal owner?
assessment current year date of application
assessment date,current year 72,800 EI Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,� indicate with whom
I Is the rt�y{iin question:Annually Assessed
El --,
If name on record is different than that of applicant,indicate below: 0 Annually Assessed
4 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `+✓
Mortgage Masters of Indiana, Inc. J�N2
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 N Cross Pointe Blvd Evansville, IN 47715 eyes c'Q��,
Name of assignee or other owner or holder of mortgage O
N Cn� ..
Address of assignee(number and street,city,state,and ZIP code) .e.-
/rnseQte amount of deduction
Does applicant own property in a If yes,what county? I What Taxing District? I Has this deduct() b requested I If yes,
I on property for
other county current year? es ❑No
in Indiana? ❑Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ont 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 the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
I I 20 I 20 I 120 I 20 I 20
20 20
I County � '/\ I Date mo h�d mar) 2,
Sign. ire of my9uditor � ///�(."1' G.-
/ ��Y�
I/We certify under the penalty of perjury nee r above and foregoing information is tr a nd correct and that the applicant is a re ident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. pate(month,day,year)
Sig ,turn(owner'/ll n- 'e) � --"Y 1/18/2022
F re ident address of applicant(number and street,city,state,and ZIP
1101 South Washington Street Princeto , IN 7670 I pate(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-1 .7
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.