HomeMy WebLinkAboutMortgage_Gollnick r., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
E-_- . `- FOR DEDUCTION FROM ASSESSED VALUATION
x• --- State Form 43709(R11/6-09) Gibson Haubstadt 2013
Prescribed by Department of Local Government Finance �.
INSTRUCTIONS: File Mark
To be filed in person or by Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar y4Jpr -riyhicf�O 3ieduction is sought. t
Must be filed with the County Auditor or County Recorder of the coun�tyy,where the property is located xJ County Auditor
on or before January 5 of the immediately succeeding calendar,{'ear. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly; s RI aunty Auditor of the
county where the property is located during the twelve(12)m 31 of each year the
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Michael Gollnick
Taxing District Key number/legal description Record number Poe umber 5t
plic
Gibson 26-19-31-304-000.056-009 Lot 436-437 East Park Addtn. 201300003567
March 1.d value of real property as of Mardi 1, /Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant e the sole
e
March 1.current year Mardi 1,current year date of application legal or equitable owner?
119600 126000 123500 El 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
Banterra Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
133 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 GI Yes ❑ No
•
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of of ty Auditor e 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/contract buyer of the afore -ntioned property on da : application is filed.
Signatur nets f ame) / Date(month,day,year)
a 6/17/2013
Fu I resi em address of applicant(number and str?et,cry,state,and ZIP code)
406 E.Gibston Street, 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)