HomeMy WebLinkAboutMortgage_Goldsberry (2) I
ey STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cbuy :E Year
FOR DEDUCTION FROM ASSESSED VALUATION
`� State Form 43709(R11/6-09) _ Gib 2013
k;,,;� Presaibed by Department of Local Government Finance �r,�rg
INSTRUCTIONS: OCTlIYT c013
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located ty Auditor
on or before January 5 of the immediately succeeding calendar year. I GIBSON Ct l JTB'odrl$6ITORer
-2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
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)
Jacob L. Goldsberry
Taxing District Key number I legal description Record number Paae number.71 Oakland City 26-14-18-104-000.078-007 I 1.3-5(e 9
Assessed value of real property as of Mortgage/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?
48,900 35,408.16 I 0 Yes ❑ No
If no,what is his I her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: • I He property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city.sate.and ZIP code)
101 NW Fourth St,4th Floor Evansville, IN 47708
I
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? r—,{ for current year?
❑ Yes 6(J No ❑ Yes 116 No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 1 20 20
Signature of County Auditor 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/contract buyer of the aforementioned property on date application is filed.
gnature(owner Date(month.day,yet)
/2
3
Full resident address of applicant(num.re.a d street city,slate,and ZIP code)
314 W First St,Oakland City, IN 47660
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 I Date(month.day.year)
Address of authorized person (number and street,city state,and ZIP code)