HomeMy WebLinkAboutMortgage_Lewis (20) .,R4=.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4�� FOR DEDUCTION FROM ASSESSED VALUATION q,. 1v.\
O 71 C� -3:� State Form 43709(R13/10-15) !/'u� ', Prescribed by Department o ocal Government Finance
_ 1 I���� File Mark
INSTRUCTIONS: f� \ \ — e ^ // G F ed with:
To be filed in person or by mail. C.
Filing Dates: 1) Real Property:Must be completed and dated tV calendar year for which the deduction is sought. 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 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)
Travis R., Lewis
Keynumber/legal description Record number Page number
Taxing District 000Z� 3 l 6 1
Patoka TL►`L ( 26-11-02-300-004.726-027
Assessed value of real property s of Mortgage/Contract indebtedness unpaid as of date f Mortgage/ Tact indebtedness unpaid as of Is n legal applicant
the sole
assessment date,current year assessment date,current year
$127,645.00 El Yes ❑ No
If no,what is his/her exact share of interest'? If owned with someone other than spouse,indicate with whom
Is the property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: Q Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc. ISAOA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 N. Cross Pointe Blvd. Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) FILED
Does applicant own property in any If yes,what county? What Taxing District? Hassy thisoaQ deductiriiy�((oc{ een requested If yes,state amount of deduction
other county J U LurlerWy96tPL yes ❑No
in Indiana? El Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c tract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in- county recorder's offi e)t at is the basis for the deduction.
COUt� county
.Lt'¢.` znd)
COUNTY AUDI I OFt
Deduction approved in the amount of:
20 20
20 I 20 I 20 20 I 20
County \ � I Date(month, y¢rar) ,�^ 2_
Signature of oupty or J ✓( ,C
I/We certify under the penalty of per) that the above and foregoing information i true and correct and that the applicant sident f Indiana and
owner/contract buyer of the aforementioned property on date application is filed. I Date(month,day,year)
Signature __full name c07/1 1/2022
.7'Gr��7 = f--�i
Full resident address of applicant(number and street,city,state,and ZIP code)
2350 West 50 North Princeton Indiana 47670 I Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code)
-rr.-.,..,ai.ie f r ner„n,ran inr'l„rie ....'- - - , -_.,,,,..r a fine not to exceed$10,000.