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HomeMy WebLinkAboutMortgage_Hale (12) d;:- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County _• I shit Year I i�.y ? FOR DEDUCTION FROM ASSESSED VALUATION `\' State Form 43709(RIO/11-08) Gibson ' '/ \ Prescribed by Department of Local Government Finance //�1'�'rr�((�1 INSTRUCTIONS: �'F>+IBtA®rlc 2013 To be filed in person or by mad with the County Auditor of the county where the property is located. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months belor year the deduction is sought. G�BSON COUNTY AUDITOR See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Thomas A. Hale Taxing District I'Key number/legal description Record number /1 Papga znumber Patoka 26-12-05-400-000.505-027/A Pt of the N Half of the SE Qtr.of Sec.5, I ki• TA 0.J 1 Assessed vale of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole Marty 1,current year March 1,current year date of application legal or equitable owner? S50,000.00 © Yes ❑ No I If no,what is his/her exact share of interest? If owned with someone other roan spouse.indicate with whom 1 11 name on record is different than that of appgcant.indicate below is the property in question:Annually Assessed El Real Property p Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Farm Credit Mid America Address of mortgagee or contract seller(number and street,city.state.and ZIP code) 15747 Neeley St.Evansville, IN 47725 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? I What Taxing District? Has this deduction been requested on property county in Indiana? for current year? ❑ m Yes ❑ No Yes D1 No COUNTY AUDITOR I Deduction approved in the amount of: 20 1 20 1 20 20 20 20 20 Signature of County Auditor I County I 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. Signature(owner's full name) ' A/` J !• L% t/ / Date IQ:onln,�'v,year) Full resident address of applicant(number and street city,stale,and ZIP codet)%rv�'/K/-' (�)/ 6 (/ 1387 E.Taftown Rd.Patoka, IN 47666 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.ray.state.and ZIP code)