HomeMy WebLinkAboutMortgage_Henrich 47.. -r"4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township I Year
eE FOR DEDUCTION FROM ASSESSED VALUATION
S� State Form 43709(R11/6-09)
Fitt 1 1 Ch 2014
% Prescribed by Department of Local Government Finance ark
INSTRUCTIONS:
To be filed in person or by mail. I n( 1 8 E6ww toed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is s uug U I� County Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located .. '�.rrr---111 ��_
on or before January 5 of the immediately succeeding calendar year. unty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audi
county where the property is located during the twelve(72)months before March 3161 AUNTY AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ryan Henrich
Taxing District Key number/legal description Record number Page number
Ft Branch 26-19-18-303-000.449-026 ��ppInss�ttp�1r1ume9qt
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicatlf`,�dSUtaf'03197
March 1,current year March 1,current year date of application legal or equitable owner?
92,800 95,918 Fl 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
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Kirkston Mortgage,LLC
Address of mortgagee or contact seller(number and street,city state,and ZIP code)
501 Cross Pointe Blvd, 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 0 No El 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 I contract buyer of the aforementioned property on date application is filed.
?Mature(owner's full name) Date(month,day,year)
Aaf A P
Full res nt address of applicant(number and street,city,state,and ZIP code)
403 E.Walnut 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)
•