HomeMy WebLinkAboutMortgage_Dillon (4) EA, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. Year
„iv.__ ' FOR DEDUCTION FROM ASSESSED VALUATION
•}� �� .) State Form 43709(R11/6-09) 51 2013
'' '' Prescribed by Department of Local Government Finance i - i < Ma�'1
..0 �1
INSTRUCTIONS:
To be filled in person or by mail. Fq�filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �He 0 2 1014.
Must be filed with the County Auditor or County Recorder of the county where the property is located Court Auditor
on or
Mobile/Manufactured 5 o the immediately succeeding as aProperty:operty: yusr. n, ❑ CO upty Recorder
2)Mobile/Manu/actured Homes not assessed as Real Property: Must file with the County Auditor of the
_J./ANIPMC.
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. GIBBON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Tony J Dillon and Sara K Dillon
Taxing District Key number/legal description 26-22-14-300-001.022-024/ 12859 South Record number Page number
Scottsdale Dr., Haubstadt, Indiana 47639
26-22-14-300-001.022-024 ao►24 Si
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 gr equitable owner?
5252,000.00 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 property in question: Annually Assessed
.-Real Property ❑Annually Assessed
Mobile Home (IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Commerce Bank
Address of mortgagee or contract seller(number and street ciN state and 71P code)
20 N.W Fourth Street, 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 If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? �/�� for current year?
❑ Yes �jJo ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 I 20 20
Signature of County Auditor County Date(month,day.year)
I/We certify under 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.
/ nature(ow, I..me Date(month,day,year)
�J
401 /24/ /13
cFull reside. .dd - s of applicant(number and street,city, state,and ZIP code)
1285' outh Scottsdale Dr., Haubstadt, IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person(number and street,city, state,and ZIP code)