HomeMy WebLinkAboutMortgage_DeVasiero-.+,l^—�� i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
;;a_��: FOR DEDUCTION FROM ASSESSED VALUATION
Stare Fortn d3709 (R77 / 6-09)
,�� z Prescribed by Department of Local Govemment Finance
INSTRUCTIONS: — 'Y L
To be lled in person or by maiL Form filed w1 :
Filing Dates: i) Real Property: Must be mmpleted and dated in the ca/enda� year for whicM1 the detluction is souqMQA1 9
Must be filed with the CounryAuditor or County Recorder of the county where the pmperty is located ''Y 7L County Auditor
on or betore January 5 oi (he immediatety succeeding calendar year. � County Recorder
2J Mobile / Manulacfured Homes no[ assessed as Real Pmperty: Must Re witA the County Auditor ol
counry where fhe property is located dunng the tweNe (72) months before March 31 of each yea �
deducGon is souaht. GIBSlIU ..,....
See ieverse side �or addi6onal instrucfions and quallfica6ons. vv�N �Y %1�1DIT�
App6cant (owner or contrdd buyer - see resUicfions on raverse Side)
SAMANTHA J. DEVASIER
Tarirg DistriC Key number / le9al descnption ��.,.,,,,m,,. _ Record number Paggflgb�9rjne�t
PATOKA 2612-15700-001.269-027-"�-.�.�<= - - - � �C11300�J0013
Pssessed vaNe of mal properry as of MoM1gage / ConUact intlebledness unpaiC as of Mortgage I CanvaG indebtedneu unpaiE as ol Is Ne apdicanl the sole
M ch �1, 7artenqty� nar/� � Marct� 1, wrtent year o6 date of a0P ication � legal or equilable ameY!
' (� !W �1 �� ,-- � � �".V'_ '❑� Yes ❑ No
If no, what is is / her ezact share ol interest? If rnmed with someone ofher Nan spouse. inditate vriN w0om
N/A N/A
If name on recortl is dfierent than tnat of applipnt, indicate bebw: Is the pmperty in question: Mnualty Pssessed
NIA ❑� Real Property ❑ MnualyAssessed
Mob�e Home (IC 67.1-7)
Name of mortgagee or coniract se0er
KIRKSTON MORTGAGE LENDING, LLC
Address of mortgagee w wnvad se0er (number and sVeet. firy, sta:e, arM ZIP tode)
501 CROSS POINTE BLVD., EVANSVILLE, INDIANA 47715
Name of assignee w o;her owner or hdEer of mort9age
NIA
AdCress of assignee (numoer arM sheef, tlry, state, arM ZIP coda)
N/A
Does applicant wm ompeM1y in any other If yes, what munry? Wha: Ta�ting Distnal Has ihis deCuction �een requested on property
counryinlnd'una? � forwrtentyear?
❑ Yes ❑ No ❑ Yes ❑ No
COUNN AUDROR
Detluction approved in Ne amount of:
20_ 20_ 20_ 20_ 20_ 20_ 20_
Signature of CounryAUdiwr Coun.y Date (month, day, year)
1/ We certify under the penalty of perjury Nat the above and foregoing infortnalion is Vue and cortect and that the applicant is a resident of Indiana and
wner / contracl buyer of ihe aforemenlioned property on date application is filed.
5 n re(owneYS !ufl �rne) � ' Date (monfh, day, year)
� iv� izoiz
Fu� resident a0tlress of applinnt (number antl sbeet, ciry, uare. antl ZlPcade)
Person authorizeO by Guty ezecutetl Prnver of Attomey or Ey IC 67.142-07 Date (montb, tlay, year)
Address of auNOrized person (numDer and sveet, rny, stafe, and LP code)