HomeMy WebLinkAboutMortgage_Roberts (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�,�o. Coun Townshi. Year
11) FOR DEDUCTION FROM ASSESSED VALUATION
�s �. t`• State Form 43709(R1116-09) @_ 2013
Prescribed by Department of Local Government Finance F -
INSTRUCTIONS: r
To be filled in person or by mail. Ilda� v
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ail' uj��
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ ° County Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ C my Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of th
county where the property is located during the twelve(12)months before March 31 of each year the PGIBSON
COUNT
deduction is sought. Y AUDITOR
See reverse side for additional instructions and qualifications. .
Applicant(owner or contract buyer-see restrictions on reverse side)
Mark D. Roberts and Nichole D. Roberts
Taxi stns Key number/legal description 26-18-36-300-002.229-024/10415 S. Record number Page number
'6t;-
f,(J Pheasant Run, Haubstadt, Indiana 47639 01075
A s ed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
ch 1,current year March 1,current year date of application le al equitable owner?
5202,500.00 AYes ❑ 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 a property in question: Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
6209 Vogel Road, Evansville, IN 47715
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 If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
/^1 AUDITOR
Deduction approved in MI L�
20 1V�1 NO 20 20 20
5z-
Drawer NO...... •
Signature of County Audits Date(month,day,year)
CardNO. .....................
I We certify under pe to is true and correct and that the applicant is a resident of Indiana and
o er/c ct buyei ..._.._.,,. u property on date application is filed.
S a . e II name) _...satq(m nth,day,year)
Full r- i•e address pp'cant(number and street,city,state,and ZIP code) ,y\\\ \�
10415 S Ph-:sant Run, Haubstadt, IN 47639
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)