HomeMy WebLinkAboutMortgage_Moline (2) != STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' `=;9 , FOR DEDUCTION FROM ASSESSED VALUATION � (r �1 (' �,^fir�/
)�'. 41 State Form 43709(RI3/10-15) .4 V Q_ ` C / / , s2"--
S ; •-' Prescribed by Department of Local Government Finance G•�'
File Mark
INSTRUCTIONS:
To be filed in person or by mail. F rm •ed with:
Filing Dates: 1) Real Property: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 is County Auditor
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.
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See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Moline, Cameron M. & Wasson, Christy M. & Wasson, Michael F.
Taxing District Key number/legal description Record number Page number
Patoka 26-05-30-101-003.302-027 2.0 a" - 1 16 CO
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$249,850.00 I Yes El 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 the property in question:Annually Assessed
El Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller F ILA
Mortgage Masters of Indiana, Inc. ISAOA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 N. Cross Pointe Blvd. Evansville, IN 47715 2022
Name of assignee or other owner or holder of mortgage MAR U 7
Address of assignee(number and street,city,state,and ZIP code)
c*""-C Wit,- `[[[111 0
What TaxingDistrict? beAFtgt,Tst nul
Does applicant own p arty in any If yes,what county? Has this ested If yes,state amount of deduction
other county on property for
in Indiana? Yes ElNo 6- 1 Yi St)ys current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or n ct 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 is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of: ,,,,,,[[[[[[,,,���
20 20 20 20 2t, 20 20
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Signature of County Auditor County /� ^ Date 51 >�r) �2
r
I/We certify under the penalty of perjury that the above and foregoing information is true correct and that the applicant is res ent of Indiana and
owner/contract buyer of the aforementi n d property on date application is filed. � i" ,`,,..------
Sig tore(owners MI name) - l/ / 1' 7 _/ J4 /JjUonthdaear)�/pt/1 LI(/,/l1/)�''��'�'^/ 02/28/2022
Full esident�d es�applicant(number an street,city,s te,land ZI cP ode)
2591 North Benchmark Drive Pri ceton Indiana 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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