HomeMy WebLinkAboutMortgage_Hale (9)��p STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township r
�i�? FOR DEDUCTION FROM ASSESSED VALUATION
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Sate Form a3709 (Rit / 6-09)
-�'�� Prescnbed by Departmeni of Local Govemmem Finance
File Mark
INSTRUCTIONS:
To be fifed in person or by mail. Fwm fnee vnm:
Filing Dares: 7) Real Property: Musf 6e comple(ed and dated in the calendar yea� for which tAe deduction is si�QtZJQnb u�,1n}� o
Must be filed wifh the Counry Auditor oi Counry Recorder o! fhe county where (he property is located ' Y_S� �VO�Q'��
on oi be/ore January 5 0l the immediafely succeeding calendaryeac n 'Ydi nty Recorder
2J Mobile / Manu(actured Homes not assessed as Real Property: Must !le wifh the Counry Audi[or a '
county where fhe pmperty is locafed dunng the twelve (72) months befo2 March 37 0/ each year the
Acdu�tinn i< <nunM
See reverse side !o� addilional instrucfions and qualificafions. t� � ��� 87.j
ADplicant (owner w co�(�� r s�sLictions on laverse side)
Steven K and+2himda L ale �
Taxing Oistnct Key number / legal OescriOlion num r e number
Johnson 2623-02-400-002.765024/ Pt W2 E2 2-4-10 � �
Assessed vaWe ot real properry as of Mortgaga I ConVaci indeb;edness unpaid as of Mortgage / ContraU indebtetlness unpai0 as of Is �he applicant Ne sde
Mart�h 1, arrentyear March 1, wrtent year date of application legal w equilade ovmer7
312000.00 ❑� Yes ❑ No
If no. what is his / her eracl share of interest? It owned wiN someone oNer Nan spouse, intlicate wiN whom
If name on record is CiHerent Nan Na1 of applicant, indicate Oebw: Is Ihe pmperty in ques6on: MnuaOyASSessed
❑� Real Property ❑ MnuallyASSessed
Mobile Home QC 6-1.7-7)
Name of mortgagee or mntract seller
First National Bank of Carmi
AdOress of mwtgagee or wnVan se0er (number aM slreef. dty, sfate, aiM ZIP cotle)
201 E Main Sireet Carmi IL 62821
Name of assynee or other owner or �daer of mortgaga
AtlCress of auignee (number antl sireel. ciry, stare. and ZIP code)
Does apdicant own pmperry in any aNer 11 yes. wAat counry? lM�at Taung DisWa? Has this deduaon been requested m pmperty
caun m InCiaw? far curtent eaR
ry ❑ Yes ❑� No Y ❑ Yes ❑ No
COUNTY AUDITOR
Deduc•,ion approved in Ne amount of:
zo zo zo _ zo zo _ zo _ zo
Signamre oi CounryAuditor Lounry Date (monN. day, yea�
I I We certi(y under Ihe penalry of perjury Ihat the above and foregoing infortnaGon is tme and cortect and tha[ Ihe appliwnt is a resident o( Indiana and
/ contract buyer of Ihe forementioned property on date applicatlon is (led.
griature ownels fu0 name) Date (monlh, tlay. yea�
02111113
reSiEent atlE:ess of ap wnt (number antl slmef. ary, state, and ZIP code)
4044 E St Rd 68 Haubstadt IN 47639
Person author¢ed by tluly executed Paxer ot Attomey w Dy IC 6-1.142-0J Dare (month, Cag year)
Addressotauthonzedperson (num0erandslreeGCiry,State.andZlProde)