HomeMy WebLinkAboutMortgage_Norris III ,;ya nti: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-'` �y. FOR DEDUCTION FROM ASSESSED VALUATION
•f$ State Form 43709(R11 6-09) Gibson Ow ille 2022
.,yam ++ Prescribed by Department of Local Government Finance FIL
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INSTRUCTIONS: File Mark
To be filed in person or by mail. /^�Ap
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year APARicl tle tion is sought. F. m filed with:
Must be filed with the County Auditor or County Recorder of the county where the pr its located
on or before January 5 of the immediately succeeding calendar y =,County Auditor
2.) Mobile/Manufactured Home not assessed as real Property: �e wi Co ty Auditor of the ounty Recorder
county where the property is located during the twelve(12)montfibe I.if ear the
deduction is sought. NTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) �0�� �7
* Jack E.Norris,Ill
Ta Dis ct Key number/legal description �/ ^ 1,, p Re ord number Page number
'WILLOW BROOK 37a/a�Q-1 t - 21-d CYO-DD`,-,� 9-w) � "G°OA
As esse alue o r al property as of Mortgage/Contr t indebtedness 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 0 Yes D 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
0 Real Property ❑ 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 /_t\\
Address of assignee(number and street, city,state, and ZIP code) (`l\-��!"J�
_s applicant own In yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
property0 Yes No X.Yes No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
S' l re Co Au for _ County Date(month,day,year)
I /We certify under the penalty of perju 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 is filed.
Signature(owner's full name) � ilZ Date(month,03l12/2022ay,year)
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)