HomeMy WebLinkAboutMortgage_Anderson (12) aL,,, ,._,__ v.,_._3(0c _coo , s-8 c ..... 0 )..:/__
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Townsht Year
iJ r.
�,�aa��..iitt�;? FOR DEDUCTION FROM ASSESSED VALUATION Gibson �-1 0 2022
^'^s>�, State Fenn 43709(K14/1-201
Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: To be filed in person or by mall. Form filed with:
Filing Date: Form must be completed and dated In the calendar year for which the deduction Is sought 0 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 calendar year in which the property taxes am first due and payable. ❑County Recorder
See reverse side for additional Instructions and qualifications.
Appsc nt(owner oreanuact buyer-see rostrfcaons an reverse side)
Rian Blake Anderson and Caolmhe Brocklebank Record number P r
Troths District Key number/legal description
orillaaetear"'+ w t 1 W gal 26-12-17300-000.566-027/PT SW 17 2 10 7.52 AC n?OC
Assessed"value of real property as of mortgage/Contract Indebtedness unpaid es of Mortgage I Contract indebtednea Is applicationtheor ridable ownerT
assessment date.current year assessment data,current year dateof application
50.00 $70,000.00 es 0 No
If no.what la his/her exact share of interest? If owned with someone other than spouse,indicate with whom
a name on record le different than that of applicant.Indicate below: Is the rty In question:Annsany Assessed
cal Property 0 Annually Assessed
Name of mortgagee orcontract sellerFmED
Mortgage Masters of Indiana,Inc.
Address of mortgagee or contract:seder(number end street Wry,state,and ZIP coda)
501 N.Cross Pointe Blvd.,Evansville,INOa 47715
Namadaadgtoe or other owner or homer of nwneage FEB 2 $ 2022
Address of assignee(number and sheet city,state and ZIP coda)
Doe applicant own property if yes,what county! Whet Taxing Dlsbict? Han this daducdon been Ilya..state.amount 01 da_/`.�
other county on property for i i /7. 9 A/�yt�j_�.,e)
M Indiana? p Yes No current yeah b"'�L[L4C c..4/ .//Ir( rw)
A person Is not entitled to this deduction unless the person has a balance on the person's mortgage or contract lode $9,30,4k0DelOMINAVENTOR
recorders office(Including any home equity line of credit that is recorded In the county recorders office)that is the basis ror the deduction.
COUNTY AUDITOR
Dedodton approved in the amount d..
20 20 20 1 20 20 20 20
Signature of Cohmty Audltor4j ait.p 47- County Date(month.day.Npor�)
•/��tlk `{it_t� Gibson Pl t3 O/ac1.
I/Wa certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant Is a resident of Indiana and
r/co a buyer)0,4he atorementicned property on date application Is filed. yf P/ _
fr.
reside a of epp ru�((number and..beat ony.slate.and ZIP code) F
/694 E 150 S,Princeton,IN 47670 Date(mono,day.road
Person authorised by duly executed Power of Attorney or by IC e-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 end a fine not to exceed S10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Name of applicant Name of mortgagee or contract sellerRian Blake Anderson and Caolmhe Brocldebank Mortgage Masters of Indiana,Inc.DataHad(� fi ?79�' Amountdindabtadrhessraxlrh9 wsW0t
er ( ,r;74.2 $7D.paD.oD pG`''`n``` i"'>7s7LED
B 2 8 2022Key number/ gal17_300- -`/�26-12-17300-000.586-027/PT SW 17 2 1O Z52 AC /ounry �te t�hau'da "� {/r!/�./sbnatu/IVcl�my AudRer/CoRe tki �e`///II cGibson / I=2... r1� �j j�j''_,,r,[
,`Q I l�`�4KI 4.e.t a. -.✓erti iata)
GIBSON COUNTY AUDITOR