HomeMy WebLinkAboutMortgage_Dehosse e >. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
•a_ . FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R1116-09)
Prescribed by Department of Local Government Finance
01STRUCTIONS: ile M rkl
o be filed in person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located 9
linty
Auditor
on or before January 5 of the immediately succeeding calendar year. R 2�9dnty 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 71,
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deduction is sought. -jlJ;ij_l
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Diana M. Dehosse yb¢¢
Taxing District Key number/legal description Record number Page 1056f U0eD.
Hazleton 26-02-59-032-000.124-019/PT MD 32-1-10 0.5275 AC 201300001147
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,anent year date of application legal or equitable owner?
$4,200.00 $105,000.00 El Yes ❑ No _ _
If no.what is nis/her exact share of interest? If owned with someone other than spouse.indicate with whom
n/a n/a
If name on record is different than that of applicant,indicate below Is the properly in question:Annually Assessed
n/a O Real Property ❑Annually Assessed
Mobile 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, Indiana 47715
Name of assignee or other owner or holder of mortgage
n/a
Address of assignee(number and stme(city,state,and ZIP code)
n/a
s applicant own[rope ny other If ye what county? t Taxing District? Has this deduction been requested on property
minty in Indiana? ❑ n�O- 1 for current year?
1 ty Yes No 16 N3 A aT� y ❑ Yes No
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.
Signet .e owners full name) / Date(montL day,ye 1
n. ,�.Onil( I OCJ / I /2013
Full resident address of applicant(nu er-and t,cay,state,and ZIP code)
107 East Third Street,Hazelton,Indiana 47640
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) 1�
Address of authorized person (number and street,city,state,and ZIP code) 'y``�
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