HomeMy WebLinkAboutMortgage_Millard '► STAI r OF MORTGAGE OR CONTRACT INDEBTEDNESS
e�`sue'�� County Township Year
FOR DEL... -IN FROM ASSESSED VALUATION
a` �` State Form 43709(R; Gibson P a Q 2023
�;01.- Prescribed by Depa -1 Government Finan —1 _ RI. EIVCD (k /�
INSTRUCTIONS:To be filed in person c.. ..� 1� �)0 1 File Mark
i O C I O 6 2022 Form filed with:
Filing Date: Form must be completed and dated in the calendar y: r for which the deduc..,n is sought. �{
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property 1/�. County Auditor
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. ,❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Maricris E.Millard
Taxing District Key number/legal description Record number Page number 028 26-12-07-203-001.900-028/Old Plan 98 Pt,Gibson County a'D 3 /q
S `
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app is th sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
104,025.00 al Yes ❑ 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: IT / ■ iD Is the property in question:Annually Assessed
® Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller O C T 0.4 2022
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)e.y�_
PO Box 918,Evansville,IN 47706 //Lcc',h z ' a. � :,..)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? I Has this deductio be requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o 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 office)tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor 0Gt., County \ Date( tly y,year)
I/We certify under the penalty of perjury that the above and foregoing information is true a d correct and that the applicant a r4sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
l/1 Gl VI-ce.'t • NV(16i v d 9/28/2022
Full resident address of applicant(number and street,city,state,and ZIP code)
425 North Seminary Street Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
9/28/2022
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$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant a c
or contract seller O 37
Maricris E.Millard Fil Id f I ank -- nDate filed((mmo th, r) Amount of indebtedness Taxing District m
t1t J((� 2 b�a�s.�o --0 Z3 m
Key number/II gal escription 20226 ��� _ L 13�
26-12-07-203-001.900-028/Old Plan 98 Pt,Gibson County `�`
Signature of County Auditor/County Recorder , DaDate(m nh, ay year)
M W -t r•S LS CCN)..../
GIBSON COUN UDIT(J • 0 nUV^2'Z