HomeMy WebLinkAboutMortgage_Norris (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESScounty Township Year
a, FOR DEDUCTION FROM ASSESSED VALUATION ���� 02 / n Year
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2'\ahj+ State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. PI County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is4.
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)
Norris, Sydney D.
Taxing District Key number/legal description Record number Page number
Fort Branch 26-19-19-101-000.513-026 0?02 3 S'1Z
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of date f Mortgageapplication/ Tact indebtedness unpaid as of Is Is the a pli aabl ent he sole
assessment date,current year assessment date,current year
$192,500.00 El 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: I t e property in question:Annually Assessed
ILE f Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) A u G 2 3 2U Lt'
PO Box 918 Evansville, IN 47706
Name of assignee or other owner or holder of mortgage Yta)
- AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
GIBBON COON 1
Does applicant own property in a If yes,what county? What Taxing District? Has this deduc i n en requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes El No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or 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 offi e)th is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 CD
20 20 20 20
CountDate(moot dy yeab2,nSignature of County Auditor1{1 `��--� `^ C ` LJ L
1�• 1 �/ V V ✓v
I/We certify under the penalty of perjury that the above and foregoing information is ljue and correct and that the applicant is a resident of Indiana and
own r/contract buyer of the aforementioned property on date application is filed.
Date(month,day,year)
Signatu (owner's full nlame) (( '�t'/�) �1 08/1 9/2022
�y/ ,io - r 1.(7 ?.1...c f
Full resident address f applica (number and street,city,state,and ZIP code)
501 East Oak St eet Fort Branch Indiana 47648 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10 nnn