HomeMy WebLinkAboutMortgage_Heldt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e _ _. % FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
�' -- Prescribed by Department of Local Government Finance
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 year for which the deduct(
Must be filed with the County Auditor or County Recorder of the county where the prope I at Rik 1 County Auditor
on or before January 5 of the immediately succeeding calendar year. 3-,/ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coun dit
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. MAR 312014
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
ETHAN WILLIS HELDT - !
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Taxing District Key number/legal description GIBSON CO S ....p OR PagcyprWt
MONTGOMERY TWNSHP 26-17-28-100-000.589-021/26-17-28-100-004.151-021 • �V„/ 155 tCr�/J+`J[
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,anent year March 1,current year date of,application �1 00 legal or equitable owner?
$ 10/cl H5a. 12 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
12 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
KIRKSTON MORTGAGE LENDING,LLC
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 CROSS POINTE BLVD., EVANSVILLE, INDIANA 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant cam 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 ❑ No ❑ Yes ❑ No
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/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/contract buyer of the aforementioned property on date application is filed.
Sign (owne N me) Date(month,day, )
02/ 4 /2014
F resident ad r of applicant(number and street,dry,state,and ZIP code)
8751 S.1025 W.,Owensville,Indiana 47665
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)