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HomeMy WebLinkAboutMortgage_Adams (2) ■ �"'".o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year V__ A FOR DEDUCTION FROM ASSESSED VALUATION x State Form 43709(R11/5-09) Gibson Haubstadt 2014 �'; Prescribed by Department of Local Government Finance I INSTRUCTIONS: by F1 trite61 : To be filed in person or b mail. vrm' Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. J County Auditor Must be filed with the County Auditor or County Recorder of the county where the property is located Y on or before January 5 of the immediately succeeding calendar year. NOV 2 2(jtnty 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' deduction i is sought. I n/ See reverse side for additional instructions and qualifications. �(�jy1tL.0iyj,'(� Appbrant(owner or contract buyer-see restrictions on reverse side) GI©SON COUNTY AUDITOR Karen S.Adams Taxing District Key number/legal description em P v� Haubstadt 26-18-36-404-000.523-009 R TOC1:s Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract irCebtedness'unpaid as of s the applicant the sole March 1,current year March 1,current year date of application legal or equitable owner? 90,800 117,419.50 I O 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 belay. Is the prdpeny in question:Annually Assessed 17 Real?Property El Annually Assessed I Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Old National Bank Address of mortgagee or contract seller(number and street,city,date,and ZIP code) 1 Main St. Evansville, IN 47708 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 this deduction been requested on property county in Indiana? for current year? ❑ Yes O No I ❑ yes ❑ No I COUNTY AUDITOR Deduction approved in the amount of: 20_ 20 20 20 20 20 20 Signature of County Auditor County Date(month,day,year) I/W- ertify 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 owne /contract buyer o entioned property on date application is filed. - Sig .t (owners fun Data(month,day.year) per: 0 11/19/2013 oil r: Went address ( caber and street city state,and ZIP code) 1 r S.Haven Dr.Haubstadt, IN 47639 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 sheet,city,state,and ZIP code) I