HomeMy WebLinkAboutMortgage_Green (5) dr' a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
a. FOR DEDUCTION FROM ASSESSED VALUATION Gibson 0 Sgs 2022
�,� State Form 43709(R14 1 1-20)
si. 4.4 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. 10 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property Recorder
is located on or before January 5 of the calendar year In which the property taxes are first due and payable. Coon ty
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-sea restrictions on reverse side)
Ashley Ann Marie Green and Christian Green Record number page number
Taxing District Key number/legal description
Fort Branch 26-18-13 401-000.240-026/PT W SE 13-3-11.231 AC c Z n i q L(S
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the apequant the
sole
assessment data,current year assessment date,current year date of application t eR
$0.00 $192,449.00 ❑No
If no,what Is his/her execs share of interest? if owned with someone other than spouse,indicate with whom
is a property in question:Annually Assessed
if name on record is different than that of applicant.indicate below: Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana,Inc.
Address of mortgagee or contract seller(number and sheet city,state,and ZIP node)
501 N.Cross Pointe Blvd.,Evansville,IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number end street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? I What Taxing District? I Has tP�futon bee quested 1 If yes,state amount of deduction
other county ❑Yes ❑No current year?r Yes 0 No
In Indiana?
A person Is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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 oh
20 I 20 20 20 20 20 20
I County I Date(montt dayl ya
Signatureof cgyph(tadder / �
�l3 p 'W Gibson t,
I/We 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
owner/contract buyer of the aforementioned property on date application la filed. I Data,(prpr+yr,IjaY�yePf)22
tore Rower's full name,)( f jc/°✓rr !��- MAIL Z LU
JL�sident drew of plu (n sb'��/) ram/
/Full resident ices applicant(number end stres4 ciy,state.and Zi code)
501 N.West St.,Fort Branch,IN 47648 I pate(month,day,yea)
Person authorized by duly executed Power of Attorney or by IC e-1.1-12-0.7
Address of authorized person(number and sheet,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 S10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or connect seller
Ashley Ann Marie Green and Christian Green I Mortgage Masters of Indiana,Inc.
Date fled(month.day.year) Amount of Indebtedness I T g.DIstdetct►.ta r
3/3// I m$1s2,449.00 }
Key number/legal description
26-18-13-401-000.240-026/PT W SE 13-3-11.231 AC County Date(month,der,yea)
Sipn'ME Qf Dourly gaClipt/CourdY Recorder ,Gibson MiteLED
AL'n1l:Vn I�'.Y.��
MAR 3 1 2022 y
2J a. aW
GIBSON COUNTY AUDITOR