HomeMy WebLinkAboutMortgage_Ralph (2) •?* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ounty Township Year
•r - ;,; FOR DEDUCTION FROM ASSESSED VALUATION Qn ` .
� 0�(��r State Form 43709(R14/1-20) l."1 2022
r is-.' Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: Form 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 0
property is located on or before January 5 of the calendar year in which the property taxes ae first due County Auditor
and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Eric J. Ralph and Lisa D. Potts-Ralph
Taxing District 0
Key number/legal description 26-23-16-100-002.065-024/12226 S. Brook Record number Pa a number
224 Dr., Haubstadt, Indiana 47639 Q oc9,1 3s-4-6
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?
$332,000.00 0 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 the property in question: Annually Assessed
ll Real Property 0 Annually Assessed
�� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `FI First National Bank of Carmi
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
7500 Eagle Crest Blvd., Evansville, IN 47715 Auf, 5 2022
Name of assignee or other owner or holder of mortgage �}//
Address of assignee(number and street,city,state,and ZIP code) '.j L�.r A+'•4
GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this ded tion een requested If yes,state amount of
other county on property fo deduction
in Indiana? ❑ Yes ❑ No current year? Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c tra t 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) hat is he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 / 20 20 20 20 20
Signature of County Auditor / 1) County Date(mop1.d ye_ar) z
I/We certify under the penalty of perjury that the above and o going information is true and correct and that t e applicant is a resident of Indiana
and owner/contract buyer of the aforementioned property on date application is filed.
Signature owner's full me) Date(mouth,day,year)
xtiK �/ e /�7r�—
Full residen ss of applicant( mber and street,city,state,and ZIP code) //
12226 S Brook Dr., Haubstadt, IN 47639
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)
rhP nanaltle.e for oeriury can include imprisonment up to two and a half years and a fine not to exceed S10.000.