HomeMy WebLinkAboutMortgage_Kohl d f-----74. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS• County Township Year
f FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) Gibso� cub 2015
,�,. Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in person or by mail. 1[ (�e9.`vltf}7 4
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ,U(,3 Cu
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. ) Con - ..rder
V Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 41
, -11 ►;
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Evan D.Kohl
Taxing District Key number-legal 000.073 u7�4er PJge/nu^b�L4
Haubstadt 26-18-36-404-000.073-009 «l///JJ/YVY�� I L far /V�
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?
106,800 146,428 f7 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 Accessed
Fl Real Property ❑Annually As'Pssed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
7144 E.Virginia St. Evansville, IN 47715
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 m Indiana? for current year?
❑
Yes GI 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
-t--- , //e. 4/17/2014
Full resident address of applicant(number and street,city,state,and ZIP code)
115 S.Weber Dr.Haubstadt,IN 47639
Person authorized by duty 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)