HomeMy WebLinkAboutMortgage_Bradley ,�•RY>.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. Year
Ale__ FOR DEDUCTION FROM ASSESSED VALUATION 2014
tr, �; State Form 43709(R11/6-09) r
'et��'1 Prescribed by Department of Local Government Finance Fie 1�
s,• it
INSTRUCTIONS:
To be filled in person or by mail. �oJg14with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. FEB (J)
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. ty Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the �(nl4/t
county where the deduction is sought
properly is located during the twelve(12)months before March 31 of each yeacjt®SON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Theresa L. Bradley 026,g3-b/9-006 ODD g;3 -ooq_
Tarstrict Key number/legal description - - 0.706- Record number Page number
'"7
Street, Haubstadt, Indiana 47639 1 Soeo
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 or equitable owner?
$103,870.00 ID Yes ❑ No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indica e property in question: Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Drawer N O,„RNLI
Community State Bank of Southwestern Indian;
Address of mortgagee or contract seller(number and stn Card NO_ ..
11201 Upper Mount Vernon Road, Evansville, I
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 0 N ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20_ 20 20 20 20 20 20
Signature of County -nty 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/ tract buyer of the aforementioned property on date application is filed.
Sire ow I1 Ilname) 3, J/,e, Date(month,,day,year)
/(t address d /j/� r[Vnumb4e�annd Cie/et,g/�"�.L, //��il
Ful (dent address of applicant(number and street, ty, state,and ZIP code)
601 S 9th Street,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)