HomeMy WebLinkAboutMortgage_Kern (3)M•}�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
,d_., ` FOR DEDUCTION FROM ASSESSED VALUATION
�� ..- �.. . l State Fortn 43709IR11 / 6-09) Gib50n
�O ;� Prescribed by Department of Lotal Govemment Finance
INSTRUCTIONS: �
To be filed in person or by mail. �
Filing Dates: 1) Real Property: Musf be completed and dated in the calendar year /or which the deduction is sought.
Must be (led with the CountyAuditor or County Recorder of the county where the property is /ocated
on or be/ore January 5 of Ihe immediatety succeeding calendar year.
2) Mobile /Manufacfured Homes not assessed as Real Property: Must t/e with the CountyAuditor o( Ihe
county where the property is located dunng the hvelve (72) months before March 31 07 each year the
deduction is sought.
See 2verse side !or addifional insWCtions and quali8cations. GIB:
AppGwnt (owner or contraG buyer- see restnUions on reverse side)
Bobby L Kern and Laura A Batta
Taeing District Key number / legal descriptim ^ — � Record
Union Township Lot 14 in Penny Lynn Estates Plat Book 2 Page 121 �
Assessed value of real properry as ot Mortgage / Contract indebtetlness unpaid as of Mortgage / Conuaa intlebtedness unpaid ;
Narch 1, artent year March 1, curtent year date of aOP�icatbn
Union I 2072
S�2`f°2��'d��a�
Counry ewrder
applipnt lhe 5ole
or equitable owneR
❑ Yes ❑ No
no, what is his / her ezaci share ol interest? II owned vnth someone other Nan spouse, indicate with whom
name on record is diBerem ihan ihat of applicant, indicate belovr. Is ihe property in question: Mnualy Assessed
❑ Real Property ❑ Mnuallyf�ssessed
Mobile Home fIC 6-1.1
Name of rtwrtgagee or contract seller
Old National Bank
Address of mortgagee or convact seller (number and sheet, city, state, and ZlP code)
1 Main Street, Evansville, IN 47708
or other owner or holEer of rtartgage
Addreu of assignee (number end sfreet, city. state, aiM ZIP code)
Does applicant avn pmperty in any other If yes, what counry?
munty in Indiana?
❑ Yes ❑� No
Deduttion approved in Ne amount
20
Si9nature
20 � 20 _
COUNTY AUDITOR
20 I 20
Has this deduction been requested on property
torcurtentyeaR ❑
❑ Yes
20
Date (month, dag yea�
20
I/ We certify under the penalty of perjury that �he above and foregoing infortnation is true and correct and that the applicant is a resideni of Indiana and
owner / conVact buyer of the aforementioned property on date application is fi�ed.
�na�jre (ownels /X/l name)n � Date (month, day, yea�
7i� FI �c 09-20-10-2012
Full resident address
city, sfate, and ZIP mde)
Person authonzed 6y duly exewted Power of Attomey or by IC 67.7-12-07 I Date (monfh, day,
Address of authorized person (number and sfreef, city, stafe, and ZIPCOOe)