HomeMy WebLinkAboutMortgage_Heironimus �,.'`,""'o. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
)1- FOR DEDUCTION FROM ASSESSED VALUATION
Gibson Patoka i 2022
J _ - State Form 43709(R14/1-20) RECEIVED
` Prescribed by Department of Local Government Finance
.___- ile Mark
INSTRUCTIONS: To be filed inperson ormail. k' ,- � MAR 3 0 2022 / _
by �` ( /�l`�JI F���or(((m filed with:
Filing Date: Form must be completed and dated in the ca ndar year for which the deduction is sought- �[J County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property 'r7yg
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)
Scott W. Heironimus and Cheryl L. Heironimus
Taxing District Key number/legal description Record number Page number
26-12-20-400-001.363-027/Pt E1/2 SE&Pt W1/2 SE 20-2-10(2.42 ^az_. I '1 4 I
Patoka A) / L
Assessed value of real p erty 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?
$539,000.00 $268,850.00 loYes ❑ 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: vile property In question:Annually Assessed
F I L E DAnnuallyAssessed Real Property 0
Mobile Home 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank, ISAOA/ATIMA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) MAR 3 0 ZUZZ
PO Box 918, Evansville, IN 47706
Name of assignee or other owner or holder of mortgage / r a rf a L _
Address of assignee(number and street,city,state,and ZIP code)
G1B4ON COUNTY AUDITOR
Does applicant own prope y in any If yes,what county? What Taxing District? Has this deductio b n requested If yes,state amount of deduction
other county on property for
in Indiana? 0 Yes No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nt 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 NA--- a20 20 20 20
Signature of County Auditor y County Date/month,day,ye
��
Gibson O �'�
II We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident f Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign re(owner's full name) Date( ont day,year)
4_ Chh. �. P1-e,t- ---- ,3 1 2Z
Full resident address of applicant(number and street,city,state,and ZIP code)
1248 E 250 S, Princeton, IN 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)
The penalties for perjury can include imprisonment up to two and a half veers an.I ti..-•.---••- -------'a+^^^^