Mortgage_Hale (3) "moo STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
L• _') 14 State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
Fi Fil r(��
INSTRUCTIONS: ® D
To be filed in person or by mail. r ��l
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the CountyAuditor or County Recorder of the county where the property is located MAR 8 p County Auditor
on or before January 5 of the immediately succeeding calendar year. 13County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the y
deduction is sought. RK
See reverse side for additional instructions and qualifications. GIBBON flirU141t.I0fTp1i
Applicant(owner or contract buyer-see restrictions on reverse side)
Tina C. Hale
Taxing District Key number l legal description Record number Page number
��Y1w1
Owensville 26-17-12-204-000.237-022/Pt NE 12-3-12 .52 AC 133 1 oaG 3 _
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1.current year date of application 00 legal or equitable owner?
87,300.00 $ 1U; 000---- El Yes ❑ No
If no,wnat is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
Na Na
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
Na TA Real Property El AnnualyAssessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Kirkston Mortgage Lending, LLC
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
501 Cross Pointe Blvd., Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
n/a
Address of assignee(number and street,city,state,and ZIP code)
n/a
Does applicant own property in any other If yes.what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ ❑ for current year?
Yes No ❑ Yes El
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
i atu (owner's lull name) f Date(month.day,year)
/\p jf(jr/ a /41 /2013
ud residen•address of applicant(number and street,city,state,and ZIP code)
406 South Main Street,Owensville,Indiana 47665
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month.day,year)
Address of authorized person (number and street city,state,and ZIP code)