HomeMy WebLinkAboutMortgage_Kell (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Townshi Year
FOR DEDUCTION FROM ASSESSED VALUATIO� T��
State Form 43709 (R11 / 6-09) i'1 � 51 2013
File Mark
.�' Prescnbed by Department of Local Government Finance
, �s
iNSrRUCrioNS: FEB 4 2013
To be filled in person or by mail.
Filing Dates: 1) Real Property: Must be completed and dated in the calendar year for which/��j e deduc ion ' sou .
Must be �led with the County Auditor or County Recorder of the county wk��I�,.tG � s ocated
on or before January 5 of the immediately succeeding calendar y¢�(13C nNA1�r� Tv
2) Mobile / Manufactured Homes not assessed as Real Property: M�7§fT11Ls DGrtn m��nry ���Q�
county where the property is located during the twelve (12) months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and ualifications.
Applicant (owner or contract buyer - see restrictions on reverse side)
David M. Kell and Kelly L. Kell
Form filed 'th:
�`�' County Auditor
� County Recorder
axin � trict Key number / legal description 26-18-04-300-000.857-021 / 4341 W 525 Record number Pag numb�
ille, Indiana 47665 �Q� `� �� �
Assessed value o re I property a Mortgage / Contract Indebtedness unpaid as of Mortgage / Contract indebtedness unpaid as of Is the app ant the sole
March 1, current year March 1, current year date of application legal or quitable owner?
$77,000.00 Yes ❑ No
If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom
If name on record is different than that of applicant, indicate below:
Name of mortgagee or contract seller
United Fidelity Bank, fsb
Address of mortgagee or contract seller (number and str
18 N.W Fourth Street, Evansville, IN 47708
Name of assignee or other owner or holder of mortgage
�ss of assignee (number and street, city, state, and ZIP code)
Does applicant own property in any other If yes, what county?
counry in Indiana?
❑ Yes No
approved in the amount of:
20 I 20
.
I TWe a�rtify under penalty of perjury
owner / contract buyer of the aforem
Signature (owner's full name) A /
C(
20
County
perty in question: Annually Assessed
Property ❑ Annually Assessed
Mobile Home (IC 6-1.1-
�� �� � en requested on property
� — ��� �` ❑ Yes ❑ No
Dra`ver NO.�...... �!...��7,,,
Card NO . .....................
(month,
20
the above nd foregoing information is true and correct and that the applicant is a resident of Indiana and
ied r y on date application is filed.
Date (month, day, year)
/-�.P � i 3
Full resident address of appl' ( mber and stree , city, state, and ZIP code)
4341 W 525, Owensville, IN 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
of authorized person (number and street, city, state, and ZIP
(month, day, year)