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HomeMy WebLinkAboutMortgage_Brown (11) w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cool_ 3 l ow f�. 3p; Year (,Za 4 FOR DEDUCTION FROM ASSESSED VALUATION j ■ 7 , State Form 43709(R10/11-08) Gib _.Brai i ,,, Prescribed by Department of Local Government Finance 1t ' INSTRUCTIONS: i a'Al To be filed in person or by mail with the County Auditor of the county where the property is located. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months be h year the deduction is sought. GIBSON COUNTY AUDITOR See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Donald Lee Brown II and Kassidy C. Brown Taxing District Key number/legal description Record number Page number Ft. Branch 26-19-18-301-000.171-026/Pt of lots 65 and 66 in Hillcrest Instrument Assessed value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant 201,300001376 tne sot property g pa pa' uo a March 1,current year March 1,current year date of application legal or equitable owner? 5114,900.00 © Yes ❑ No If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom It name on record is different than that of applicant.indicate below. Is the properly in question:Annually Assessed ©Real Property p Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract setter German American Bancorp Address of mortgagee or contract seller(number and street.city,state,and ZIP code) 711 Main St.Jasper, IN 47546 Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any other I If yes,what county? What Taxing Distract? Has this deduction been requested on property county in Indiana? for current year? El Yes No 0 Yes ❑ No COUNTY AUDITOR Deduction approved in the amount of: 20 20 1 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 e afore •-ntioned property on date appli -don is filed. S'• ature e/s full/a :) t ~ Date(month.deg year) •x. . . i A_ _ ill ..i .. '_. •L .II as . EtI ..• 03/12/2013 Full r-sident address of applicant(number and street.city,state,and ZIP code) `CIR 307 E. Ulen St.Ft. Branch IN 47648 Person authorized by duty 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) ��