HomeMy WebLinkAboutMortgage_McDevitt STATEMENT FOR DE OF MORTGAGE FROM ASSEC S R CONTRACT SED VAL UATION
INDE,!$TE Count Township Year
DEDUCTION
i p
�g�e'�y , State Form 43709(R1116-09) JUN 2 6 y.firtibson Columbia 2014
,•'`,- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. �V AUDITOR ITOR Form fled with:
Filing Dales: 1) Real Property:Must be completed and dated in the calendar year for yvliigtatsyceQ)ft sddgjnt.
fg
Must be filed with the County Auditor or County Recorder of the count were the property is located County 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 properly is located 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)
Delores J.McDevitt
Taxing District Key number/legal description Record number Page r;mstrument
Columbia 26-13-22-400-000.566-006 201300003368
Assessed value of real property as of Mortgage I 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 legal or equitable owner?
102,800 100,100 17 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
GI Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,uty,state,and ZIP code)
1 Main St.Evansville, IN 47708
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city.stare.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 at:
20 20_ 20 20 20 20 I 20
Signature of C my unditoorr 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.
Sign u 0(owneMs fo1 nag r y1., f Date(month,day,year)
y^. �r//CC//pp�v EEai.�v�r 6120/2013
Full resident address of a icant(number and street,city,state,and ZIP code)
9391 E.SR 64 Oakland City,IN 47660
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)