HomeMy WebLinkAboutMortgage_Dill (4) a'.^•'! STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°E �� FOR DEDUCTION FROM ASSESSED VALUATION y I_ p �I
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State Form 43709(R71/609)
\ j Prescribed by Department of Local Government Finance
Of Of File Mark
STRUCTIONS:
be filed in person or by mail. Fo ' i ed"
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. my di1.
Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. ,I -± ?' ;I i-corder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of thgl . . a - e
county where the property 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)
BRIAN A.DILL
Taxing District Key number I legal description /Via Record number Pace number
FRANCISCO 26-13-17-303-000.094-005/s , /'i�a/Y� �i/HI/tic r J.3'L/q /0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
earth 1,current year March 1,current year date of application legal or equitable owner?
S`1, 1000.00 fZh! 800.00 0 Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
p i A N/A
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
GI Real Property ❑Annually Assessed
N A Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
KIRKSTON MORTGAGE LENDING,LLC
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
501 CROSS POINTE BLVD., EVANSVILLE, INDIANA 47715
Name of assignee or other owner or holder of mortgage
Nl,q
Address of assignee(number and street,city;state,and ZIP code)
A)1 A
s applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
aunty in Indiana? for current year?
l ❑ yes No ❑ yes ❑ No
COUNTY AUDITOR
Deouclion 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.
Signature( .s lull name) -- (month.day,year)
X a- �_ a n 08/23 /2013
dent address of applicant(number and street city.state,and ZIP code)
309 N.Division Street,Fransisco, Indiana 47649
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)