HomeMy WebLinkAboutMortgage_Kohl `jr""- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a 011e.1 FOR DEDUCTION FROM ASSESSED VALUATION Gibson 02_3— 2022
State Form 43709(R14/1-20) RECEIVED
�e� `� Prescribed by Department of Local Government Finance
APR 0 4 2022 File Mark
INSTRUCTIONS: To be filed in person or by mail. 1 ,St�� Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. [Q 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 are first due and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Evan D. Kohl and Taylor M. Kohl
Taxing District r. 1 Key number/legal description Record number Page number
Fort 1 `)i t, 1 26-19-16-100-000.329-025/SW NW 16 3 10 1.5378 AC 2-c 2 2 i 5-6`fir
A essed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Iss the applicant
the sole
assessment date,current year assessment date,current year date of application 9h equitable
$0.00 $260,200.007 Yes 0 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: Is t property in question:Annually Assessed
F I LE ll Real Property El Annually Assessed
Mobile Homee6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIIR Kte)1 2 2OZ2
501 N.Cross Pointe Blvd., Evansville, IN 47715 Fl
Name of assignee or other owner or holder of mortgage
` h i-1 NT1' o o
Address of assignee(number and street.city,state,and ZIP code) GIBSON CUU
Does applicant own property i any If yes,what county? What Taxing District? Has this deductio een requested If yes,state amount of deduction
other county on property for Yes CI No
in Indiana? ❑ Yes No current year?
A person is not entitled o this deduction unless the person has a balance on the person's mortgage o on act 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 offic )that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County A ditor _ e--- County D to o h,dayq.year)
WCMVVI�S Gibson L-2
I/We certify under penalty of perjury that e above and foregoing information is true and correct and that the applicant is a re d t of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full ame Date(month,day,year)
dul ��res�(' t address of applicant(number and street,city,state,and ZIP code) ���o2Cb��
6975 5 175 E., Fort Branch, IN 47648
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person(number and street,city,state,and ZIP code)
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