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HomeMy WebLinkAboutMortgage_Miller (9) • 444. .%- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year I DEDUCTION FROM ASSESSED VALUATION I a FOR / State Form 43709(RIO/11-08) F Gib ohnson \!.....1,.F.-27 Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark To be filed in person or by mail with the County Auditor of the county where the property is located. MAY O 2 2013 Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 6 D 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months before March 31 of each year the deduction is sought. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR Anthony J. Miller Taxing District Key number/legal description Record number Page number Johnson 26-23-16-300-000.066-024/A pt of the SW Qtr of the NW Qtr.and pt Instrument 2n1a009426943 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 I,current year March 1,current year date of application legal or equitable owner? 5141,200.00 © Yes ❑ 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 ©Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Diamond Valley Federal Credit Union Address of mortgagee or contract seller(number and street.city,state.and ZIP code) 840 Diamond Ave. Evansville, IN 47711 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? ID'Yes ❑ No ❑ 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) (/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 Jproperty on date application is filed. Signature(own full name) LF�I'°'�' V I Date(month.daY•year) 0 /1 412 01 3 Full resident address plumber and street,city,state,and ZIP code) 1509 Warrenton d. Haubstadt, IN 47639 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year) Address of authorized person (number and street.dty state,and ZIP code)