HomeMy WebLinkAboutMortgage_Coy d/.-w�.q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
� -....t FOR DEDUCTION FROM ASSESSED VALUATION
'.� State Form 43709(Rti/6-09) tI... 2014
\\\` "", Prescribed by Department of Local Government Finance _t_ :_
INSTRUCTIONS: File Mark
To be filed in person or by mail. NO`r FUrn4tiilft49:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought 1
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. ounty Recorder
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 1iBlioN cbu TY AUDI I OR
deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Derrick R Coy and Kelli J Coy II II Oar Y
Faxing District Key number/legal description (� /)') 5 rd number Page`nu`mbej
Gibson I-26 23 16 100-000.:r99-02�' 67 -l u - yet/ -oo . I $ e 5 Q
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1.anent year March 1,current year of application �t I legal or equitable owner?
27,700.00 .6 Noi 150 % Fl Yes ❑ No
1 It 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
17 Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First Security Bank
I Address of mortgagee or contract seller(number and street.cip-,state.and ZIP code)
123 S Green River Rd, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.up;state.and ZIP code)
Does applicant own property in any otner I If yes,what county? I What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ yes No for current year?I FlYes 0 N
COUNTY AUDITOR
Deduction approved in the amount of:
20 1 20 20 20 20 120 20
ISignature of County Auditor County I I Date(month,day,year)
II We certify under the penalty of perjury that the above and foregoing information is true and correct and that the i pplicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
I ignatpre-owners tug n ) , I Date(month.day,year)
A 10-28-2013
I W reap ent address of applicant reet,city,state,and ZIP code)
F 72196 S.50 W, Haubstadt,IN 47639
IPerson authorized by duty executed Power of Attorney or by IC 6-t.1-12-0 7 II Date(month,day,year)
Address of authorized person (number and street,city.state,and ZIP code)
I