HomeMy WebLinkAboutMortgage_Huelsman (2) "'- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;a _ - % FOR DEDUCTION FROM ASSESSED VALUATION
:/• State Form 43709(R11 I 6-09) Gibson Fort Branch 2014
\ / Presaibed by Department of Local Government Finance
INSTRUCTIONS: I �ii
To be filed in person or by mail. Form Bled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. NO 102 0o2g0}�.uditor
Must be filed with the County Auditor or County Recorder of the county where the property is located LW
on or before January 5 of the immediately succeeding calendar year. ❑ County 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 year the ,! � �i
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications. I
Applicant(owner or contract buyer-see restrictions on reverse side)
Beau A.Huelsman
Taxing Fort Dinah Key number I 02-000.735 p6gr F�ge,rlu
Fort Branch 26-19-18-302-000.735-026 I r6 't3I6/
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
March 1,current year March 1,current year date of application legal or equitable owner?
79,000 78,850 I 0 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate i with whom
If name on record is different than that of applicant,Indicate below: Is the property in question:Annually Assessed
O Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bancorp
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
711 Main St.Jasper, IN 47547
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
°aunty in Indiana? for current year?
❑ yes O No I ❑ Yes ID No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20_ 20 20_ 20 20
i 0
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 afore entioned property on date application is filed. I
I to■(owner's full i e) Date(month,day,year)
_+. /E2. . hi/ 141 11120/2013
F resident..dress• app S t(number and street.city,state,and ZIP code)
501 N.Hull St.Fort Branch,IN 47648
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day.year)
Address of authorized person (number and street city,state,and ZIP code)
I