HomeMy WebLinkAboutMortgage_Dix���� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Yeai
FOR DEDUCTION FROM ASSESSED VALUATION
S• SUte Fwm a3709 (R71 / 6-09) � � ^ I I Gibson Ft. Bfanth 2011
����• P2scribeC by Department af Local Govemment Finance �\
INSTRUCTIONS: le afk
To be filed in person or by mail. F f .
Piling Dates: 7) Real Property: Must be completed and dated in Me calenCar year for which fhe deduction is soughL �� ��
Must 6e bled wifh fhe CountyAuditoi or County Recorder o7 the county where the property is located A u ditor
on or before January 5 of (he immediatety succeeding calendar year. �� County Recorder
2) Mo6ile /Manulactured Homes nof assessed as Real Property: M�st t!e with (he CounryAUditor olfhe
county where the pmperty rs bcated dunng the tweNe (72) months be)ore March 31 of each year the ��
deduction is soughf.
See reverse side (oi additional instrucfions and qualificafions. G IRCnu rni i.�t.. .. �...__ _
Applicant (owner w conbact 6uyer - sea reslncfions on ieverse side)
Justin A. Dix and Tasha A. Oakley
Tazing Disbia
Gibson
rm, what is his I her exacl
26-19-19-204-001.312-026
113,313.00
tl name on recaA is dite2nt ihan that of app6cant, in0icate bebvr
Name of mortgaqee or oontrad se0er
Mortgage Masters of Indiana, Inc.
AdEress W rtartgagee a conVact se0er (number anOSVeet, uty, state. anG Z/PcaCe)
7144 E. Virginia Avenue, Evansville, IN 47715
Name oi assgnee w oNer oxner w hdder of mortgage
�b:
as o( Mort9a9e / ConVad indeEtedness unpaiE as of Is Ne appiimnt Ihe sole
tla�e of applicaGOn leqal or equitaCk owner?
125,729.00 ❑� Yes ❑ No
II owneE with mmeana other ihan spouse, indicate with whom
Is Ihe praperty in Question: Mnually hssesud
❑� Real Property ❑ MnuaOyAssessed
Has Ws tleduction been requested on pmperty
forartent year?
0 Yes ❑ No
COUNTY AUDITOR
Detluction approved in ihe amount of:
20 _ 20 _ 20 _ 20 _ 20 _ 20 _ 20
$ignature ot CaunryAUAimr County Date (month, day, yeer)
I I We certify under the enalty of perjury that Ihe above and foregoing infortnation is We and cortect and that the appliwnt is a resident ot Indiana and
owner / conVaU er o e aforemeqtioned property on date application is filed.
'�ignamre ( � ' Oate (monN, Eay, yeer)
8/16/2017
F aE reu pplBxnt ( umberantl sfrcet, city, state, antl ZlPCOtle)
E. 790 S., Fort Branch, IN 47648
Person auVwrized 6y tluly exewieE Power of Attomey or by IC 61.1-12-0.7 Date (monfh, Oay, year)
Address of au•Jqrized person (number aM street, city, state, aM ZIP code)