HomeMy WebLinkAboutMortgage_Sines an'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e! .., FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R71/ FILE
Prescribed by Department t of of Local Government Finance IL p
Ly File Mark
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar yeart�ij1,V�w�,t}I� a�Q gc lion is sought.
Must be filed with the County Auditor or County Recorder of the coutuntyywlfe a tfrVp'bperty is located County Auditor
on or before January,5 of the immediately succeeding calendar year I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Mu le with t e C n itor ofrthe
county where the property is located during the twelve(12)moot oI each year the ---
deduction is sought. GIBSON COU.
See reverse side for additional instructions and qualifications. NTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Sines, Deborah L
Taxing District Key number-101-000.p26 I Rgogr F
26-19-18-101-000.226-026 11 .W�/J)U
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the ap root the le
March 1,current year March 1,anent year date of application legal ore unable owner?
160,047.00 .Yes ❑ No
If 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
Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller I
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) I
7144 E Virginia St., Suite A, 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 II yes,what county? What Taxing District? Has Nis deduction been requested on property
county in Indiana? •rL��2ry El current year?
❑ Yes t No I ❑ Yes No
ft
COUNTY AUDITOR I
Deduction approved in the amount of:
20 20 ,r/ 20 20 , 20 20 20
Signature of myAUd ito `�L!% Count, I Date(month,day,year)
I/ e c under the penalty 000f,.,peerrjjuuJry(thatt'tth above and foregoing information is true aannd 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( m s full name) v � I Dater( n d�ytyear)
t/7/u!/1 1/A (tie) rLMyc( eC^/t ` 13
Full res'de address of pticant(number and stree city,state, nd ZIP code)
'lea E
E . VC,it 5 6-G/a- (' c& Ini Li-7(018-
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,city,state,and ZIP code)
I