HomeMy WebLinkAboutMortgage_Davenport STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ra.n t FOR DEDUCTION FROM ASSESSED VALUATION
6 r` State Farm 43709(R71/6-09) Gibson Patoka 2014
\,.,. � Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. II''II II 11 cc�1 oo OO11�9� Form filed with:
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year fo1Nhich1h2 UEtnlcion is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located in County Auditor
on or before January 5 of the immediately succeeding calendar year El County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Mu it y uditor of the
county where the property is located during the twelve(12 nth �7 f each year the
deduction is sought. FilBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Brandon K.Davenport
Taxing District Key number/legal description Record number Page number
Patoka 26-04-25-400-000.619-020 001 36q9
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the e
March 1,current year March 1,current year date of application legal or equitable Amer/
167,600 220,408 0 Yes ❑ No
If no,what is his/her exact share of interest? It 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
A Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
7144 E.Virginia St. 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 couny? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes GI 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)
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 aforementioned property on date application is filed. n I,'''^ p
S e(goner/svf�/uAgame) N L/IfLQ//n ow 'c}+( Date 7/G//3 year)
Fun residentnntt'add_tlh5s/J/ooff�ap�pliccaant(number nd street,city,aalere,and ZIP code)
702 S.Mohican Dr.Patoka,IN 47666
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)