HomeMy WebLinkAboutMortgage_Norris III (2) ' .,- ,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
11�? State Form 43709(R11 6-09) Gibson /P ceton 2022
�,* Prescribed by Department of Local Government Finance FILED C3 '4--
•
INSTRUCTIONS: File Mark
To be filed in person or by mail. APR 1 1 2o2
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduc n is sought. orm filed with:
Must be filed with the County Auditor or County Recorder of the cou here the property is located
on or before January 5 of the immediately succeeding calendar yearn. County Auditor
2.) Mobile/Manufactured Home not assessed as real Property: namrtr�eItri��� �f the
county where the property is located during the twelve(12)months before March erEl a County Recorder
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer—see restrictions on reverse side) laClaA ��9
* Jack E.Norris, Ill
¶;464
t Key number/legal description Record number Page number
n 'PT W 5-2-10 1.00 AC C-1r(;at6p-'4:2-OS-6a-Oa4•�StX-0.27 ��
ssessed value of real property as of Mortgage/Contract i debtedness 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?
* $0.00 *$0.00 *$270,000.00 ❑X Yes ❑ 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 the property in question: Annually Assessed
El Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
' First Robinson Savings Bank, N.A.
Address of mortgagee or contract seller(number and street, city,state,and ZIP code)
* 501 E.Main Street, P.O. Box 8598, Robinson, IL 62454
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street, city,state,and ZIP code)
Does applicant own property in any other In yes,what county? What Taxing District? Has this deduction been requested on property
') county in Indiana? for current year?
❑ Yes 4, No Yes "��`����YYY o
COUNTY AUDITOR
Deduction approved in the a nt of:
20 20 20 20 20 20 20
Signs of unty do Calizz: County Date(month,day,year)
I/W certify under the penalty of perjury that hbove 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 is filed.
Signature(owner's full name) )1 ___ ,..I.-- Date(month, day,year)
✓( 03/12/2022
Full resident address of applicant(number and street,city, state,and ZIP code)
' 7551 S CR 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,year)
Address of authorized person(number and street, city, state,and ZIP code)