HomeMy WebLinkAboutMortgage_KlumpF-- Y -� -
�� S��^v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count "Township -� - Year
a,_„ ; FOR DEDUCTION FROM ASSESSED VALUATION -• °—. �
' State Fortn 43709 (R11 / bq9) Gibson� � Johnson� � 013
' ;� Prewibed Cy Department of Local Govemment Finance jjj���
INSTRUCT/ONS: NOVF�Ie���2 �
To be filed in person or by mail. Fortn fded with:
Filing Dates: 1 J Real Property: Must be compfeted and dated in the ralendar year fo� which the deduction is soughL C.
Must be filed with the CountyAUditor or County Recorder o! the county where the property is located n nty Auditor
on or before January 5 0/ the immediately succeeding calendar year. ��SON Q�j�Q'ry C Rewrder
2) Mobile / Manufactured Homes not assessed as Real Property: Must �le with fhe CountyAuditor o AUD OR
counry where the property is bcafed dunng the fweNe (72) months bePore March 37 0! each year the
deduction is sought.
See reverse side for additional insfrucfions and qualifications.
Appliwnt (owner or cont�-dct buyer - see restnclions an reverse vde)
Brent D. Klump
Ta<ing Distnct Key number / legal descrip6on Recortl number Pa e number
Johnson 26-2315-400-001.508-024 p�0� ��
hssessea value of real properry as of Mortgage / ConVact indebtedness unpaid as of Mongage / Contraa indebredness unpaid as of Is the applicant Ne sole
Ma¢h 7, artent year Marc� 1, current year date of appliration legal or equitable owner?
200,000 139,000 ❑� Yes ❑ No
If no, what is his / her exact 5hare of interest? If owned vriN someone other than spouse, indinte w¢h whom
If name on record is Eifierent than that of applicant, intlicate below: Is lhe property in question: Mnuaily Assessed
❑� Real Pmperty ❑ MnuallyPSSessed
Mobile Home (IC 6-7.1-7)
Name of mortgagee or contract seller
Old National Bank
Atldress of mortgagee or conVac� seller (num6er antl streeL ciry, s(ate, end ZIP code)
1 Main Street Evansville, IN 47708
Name of assignee or other owner or holtler of rtwrtgage
Address of assignee (number and stleeL uty, state, and ZIP code)
Does applicant own property in any oNer If yes, what counry? 4Vhat Taxing Distnci? Has this deduction been requested on pmperry
county in Indiana? O NO for wrtent year7 � Ye5 ❑ No
❑ Yes
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 _ 20 20 _ 20 20
Signature ot Counry Auditor County Date (mon�h, day, yea�
I/ We certify under the penalty of perjury that the above and foregoing infortnation is Irue and wrteci and that the applicani is a resident ot Indiana and
owner / conVact buyer of Ihe aforemeniioned property on date appliwtion is filed.
Si9 e(owne/s u/l na Date (monfh, day, yea�
�
11/08R012
Full resident adaress of applicam (number and siree ciry, stafe, and ZIP code)
3370 E. Warrenton Rd. Haubstadt, IN 47639
Person auNOrized by duty exewted Pov+er of Attomey or by IC E7.7-12-07 Date (month, dag yea�
AdOress of auNOrized person (numbei and sbeet, dty. stafe, and ZIP code)