HomeMy WebLinkAboutMortgage_Kohlmeyer ��,.. o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,?' * FOR DEDUCTION FROM ASSESSED VALUATION
— " 51 2013
}H _ State Form 43709(Ri 1 /6-09)
\< v ' Prescribed by Department of Local Government Finance F
INSTRUCTIONS: F 1 L ',r
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 1 e�ft1
Must be filed with the County Auditor or County Recorder of the county where the property is located MAR C 1 T 2013ounty Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ County 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 J/L.._--lL-�i�
deduction for is onal sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Justin H. Kohlmeyer
Taxi District•t ' Key number/legal description 26-12-28-400-001.335-027/2340 E 350 S, Record number Page number
Princeton, Indiana 47670 /3 / L( a °--
Assessed value of real property a of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legs or uitable owner?
5160,000.00 es El 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: Is the property in question: Annually Assessed
Is
t, eat Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street city.state.and ZIP code) _ _
4401 Theatre Drive, Evansville, IN 47715 I � -- - -
,
Name of assignee or other owner or holder of mortgage n /e if
Address of assignee(number and street,city, state,and ZIP code) Drawer wer IlO —
••.Y................
Does applicant own property in any other If yes,what county? What Taxing District? Card 2 — L
county in Indiana? r C ./.., / Z/
❑ Yes No •••••"""••
—
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature Auditor p _ County Date(month,day,year)
I/We certify under penaltylty✓oyff'`perrjjuuryyy}tth at 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.
Signature o ners full name) Date(month,day,year)
II r dent addr ss of a ! number and street,city,state,and ZIP code)
2340 East 350 South, Princeton, IN 47670
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)
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