HomeMy WebLinkAboutMortgage_Dike (5) .�.. *F STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
A 1 FOR DEDUCTION FROM ASSESSED VALUATION
5' aState Form 43709(R11 6-09) RECEIVED Gibson `—tom 2022
00,
Prescribed by Department of Local Government Finance � T
MAR30202Z l
INSTRUCTIONS: l Inn ? I File Mark
To be filed in person or by mail. 1 llV//t JtS�'t /I ldd���'��� ��, r--
Filing Dates: 1.) Real Property: Must be completed and dated in t calendar year for which the deduction is sought. Fo filed with:
Must be tiled with the County Auditor or County Records of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. County Auditor
2.) Mobile/Manufactured Home 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 Li County Recorder
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
* Kerry B.Dike and Rhonda Dike d21
Taxing Diricrt Keynumber/legal description / Record nu bar Pa r
• [J!i X . ,*PT NE 9-3-12 2 AC �� _� —�q��0—00"7.� �� I
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness--- Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
* S0,00 *$0.00 *$62,000.00 ®Yes 0 No
If no,what is his I 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
* The First National Bank of Carmi II ED
Address of mortgagee or contract seller(number and street,city,state,and ZIP co e
• 201 E Main St,P.O.Box 70,Carmi,IL 62821 0 2022
Name of assignee or other owner or holder of mortgage MAR 3 /�
Address of assignee(number and street,city,state,and ZIP code) �, yYI '414
N�.t tr„,i�NTv AUDITOR
Does applicant own property In any other In yes,what county? IWh®A�Ig Ofilrlct? Has this deduction been r qu ted on property
county in Indiana? for current year?
0 Yes IM/No Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of:
20 20 1_ 20 20 l ` 20 20 1 20
` Signature of County Auditor �` _ram County kS�" Date[rppnt�r a� 2rZ
I I We certify under the penalty of,J perjury,tth\t the above and foregoing Information is t correct and that the appliicaanl`Is a`r Ident of IndianaL and
owner/contract buyer of the aforementioned property on date application is filed.
77TIgn i�t owner2 full ) - � Date(month,day,year)
"""'' ,/ "—c_h_52_,' 02/23/2022
Full resid t address of applicant number and street,cate,and ZIP code)
* 557 950 W.Owensville,IN 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yeah
Address of authorized person(number and street,city, state,and ZIP code)