HomeMy WebLinkAboutMortgage_Rose .Ms!--.r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ¢ounty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION t
i; y State Form 43709(R13/10-15) 9-S .ViNQ Cam, C^1w'--''`+' '`t' Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS:
To be filed in person or by mail. F m 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.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Rose, Michael A.
Taxing District Key number/legal description Record number Page number
Montgomery 26-17-04-400-001.434-021 c90t9Q 1 10a5
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?
$235,353.00 El Yes ❑ No
If no,what is his/her exact share of interest? If owned with someonene T
other than spouse,indicate with whom
-1-LrIf name on record is different than that of applicant,indicate below: IsDperry in question:Annually Assessed
], ' ■ I 1 Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc. APR 04 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 N. Cross Pointe Blvd. Evansville, IN 47715 .c.,,C a .tiCi-e,,.41
Name of assignee or other owner or holder of mortgage GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own prope in any If yes,what county? What Taxing District? Has this deductio b requested If yes,state amount of deduction
other county on property for
in Indiana? El Yes (� current year? es ❑No
A person is not entitled to deduction unless the person has a balance on the person's mortgage or cot 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)t at's the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date.(mo a ar/
I I We certify under the penalty of perjury that the above and foregoing information i tr and correct and that the applicant i a resident of Indiana and
owner/contract b of the aforementioned property on date application is filed.
Si n e(owners f N �'�^C Date(month,day,year)
03/30/2022
Full resident address of applicant(number and street,city,state,and ZIP code)5492 S State Road 165 Owensville Indiana 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
rvi v Or
Address of authorized person (number and street,city,state,and ZIP code) CD -B
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