HomeMy WebLinkAboutMortgage_Staggs (2)•^• . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
a_^�e��a
d���i!piS. FOR DEDUCTION FROM ASSESSED VALUATION
s:� �,�` StateFOrm43709(R77/6-09) 51 2012
�'•,� i e ark
Presaibed by Department of Local Govemment Finance
�,e_..,v Q
INSTRUCTIONS:
To be filled in person or by mail ,.� filed with:
Filing Dates: i) Real Pioperty Must be comp/eted and dated in the calendar year lor which the deduction is sougl�J.0 T 1 � ��
Must be filed with the County Auditor or County Re�rder o( lhe county where fhe property is localed � County Auditor
on or 6efore January 5 0l the immediafe/y succeedin9 calendar year. C��� � County RecArder
2J Mobile / Manufactured Homes nof assessed as Real Property: Musl file with the County Auditor ol the
county where the propeRy is located dunng the twelve (72) months be(ore March 37 oteacf�yBaSrON COUNTY AUDITOR
deduction is sought. ��
See 2verse side foi additional insfructions and qualificalions. _
Appiicant (ownerorcontrau ouyer- see resn
Darren Staggs and Beverly A. Staggs
Taxing Distric� K,
�l , _ � A
�O��wo-°' �
P
2
Assessed value o( real property as of
March 7, current year
If no, what is his / her eaad share of intere5t9
If name on record is different than that of app
on reverse
number / legal tlescription 26-18-36-300-001.872-024 / Property
South Huniers Crossing Dr. Haubstadt, Indiana 47639
18-36300-001.872-024
as
March 1, curtentyear
5368,000.00
oe of mortgagee or contract seller
3nsville Commerce Bank
ress of mortga8� or contracl seller (number am
N.W Fourth Street, Evansville, IN 47708
ne of assi9nee or other owner or holder of mortg��
street,
pplirant own property in any other
in Indiana?
❑ Yes
20 _ � 20
C �-
I/ We certify under pe alty of
owner I contred buyer of the +
10221 Sauth Hunters
iry, sfate.
C7 No
below:
date of application
someone
Rewrd number
�D/a,
ebtetlness unpaid as of
spouse,intlicate with wh�
legal oy equitable owneR
C�Yes ❑ Na
Real Property ❑ Annualiy Assessed
Mobile Home (IC 6-1.1
�
� J
f yes, what counN? p�1\'Cl' � �..�0 I�.. .. ... .. c6�
�r?
�050........ -
� C:ll'(1 �0 . ............. _
20_ 20_ 20_ 20_
on
r�
thai ihe above and (oregoing information is We and corred and that the applicant is a resident of Indiana and
mtioned property on date application is filed.
Date (month, day, yea�
G-ZI-12
�}bei and streeC ciry, sfate, an�
Dr., Haubstadt, IN 47639
ower of Attomey or by IC 6-1.�
person (number antl s(reef, ciry, sfate,
(month,