HomeMy WebLinkAboutMortgage_Coffman (2) =si. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
> FOR DEDUCTION FROM ASSESSED VALUATION Gibson �Patb ca 2022
i_ ` State Form 43709(Ri 1 6-09) c,)him j
•,,;.. �,+ Prescribed by Department of Local Government Finance at ��A '
File Mark
INSTRUCTIONS:
To be filed in person or by mail. i
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. Form filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located County Auditor
on or before January 5 of the immediately succeeding calendar year.
El 2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of the County Recorder '
county where the property is located during the twelve(12)months before March 31 of each year the
L—ideduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer—see restrictions on reverse side) I
• William J.Coffman and Brie A.Coffman
Keynumber/legal description Record Pqyumber Page nuUII�yer
Taxing District 9 (fD-i�OD•yf�J°I-DI g L t 3 l v
• �� �(�/C� � •PTENE261111.155Ac�a6-V�``�b'� I ��
Assessed value of real property as of Mortgage/Contract i ebtedness 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? j
$0.00 `$0.00 •$100,000.00 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: FILE Is the property in question: Annually Assessed
i
ID
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
• First Robinson Savings Bank,N.A. OCT 0 4 2022
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 �� / `l L
Name of assignee or other owner or holder of mortgage C AUDITOR+OaR/
GIBSON COUNTY UDIT
Address of assignee(number and street,city,state,and ZIP code)
Has this deduction beon a uested on property
Does applicant own property in any other In yes,what county? What Taxing District? for current yeah /�,"
county in Indiana? Yes �1 No
0 Yes -.,./No C
COUNTY AUDITOR
Deduction approved in the amount of:
20 } 20 1 20 l 20 20 I 20 I 20
1
Signature of County Auditor
County Date(month,day,year)
I/We certify under the penalty of perjury that the above d 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. I Date(month,day,year)
Sig aturo(owners full name) W 09/21/2022
Fu l?esiIll d nt address oY pplicant(number and street,city,state,and ZIP code)
• 2115 W 350 N,Patoka,IN 47666 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)
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
William J.Coffman and Brie A.Coffman First Robinson Savings Bank, N.A.
y year) to r �2 I Amount of indebtedness '0 0 O o O I Tax_ in9 District W� ���
Date filed(month,day, 1(� / l p _
Key number/legal description26-0 26-100 000.859-018/PT E NE 26 1 11 1.155 AC 2 L1 3 Q
County F I L E I�D tOate Lk 1_0 1 2_
Signature of County Auditor/�/County RecorderI Gibson Z
c.:61.---...„---\,_
OCT 0 4 2022 IN2208132
Statement of Mortgage or Contract Indebtedness
a. .A ;,14)
GIBSON COUNTY AUDITOR