HomeMy WebLinkAboutMortgage_Heseman ,,.y Art STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
db 's FOR DEDUCTION FROM ASSESSED VALUATION -
F�l S State Form 43709(R11 /6-09) 51 2014
Prescribed by Department of Local Government Finance g� File Mark
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INSTRUCTIONS:
To be filled 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 dedr pn sought.
Must be filed with the County Auditor or County Recorder of the county where the property is/oca(ed'1Y'' ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. �,t����, V • County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County A*or of the
county where the property is located during the twelve(12)months before March 31 of each year the I i1
deduction is sought. +0'ln�Pp1jOR
See reverse side for additional instructions and qualifications. O Vdj`(
Applicant(owner or contract buyer-see restrictions on reverse side)
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William C. Heseman and Brandice E. Penner
Taxing District Key number/legal description 26-17-09-200-001.361-021 /5542 South Record number Page number
State Road 165, Owensville, Indiana 47665 . f
26-17-09-200-001.361-021 .2O/ 1 I rg I
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 9r equitable owner?
$70,000.00 l&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
LFJ Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Community State Bank of SW IN
Address of mortgagee or contract seller(number and street.city.state and 71P code)
11201 Upper Mount Vernon Road, Evansville, IN 47712
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 iwany other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? hdJ/ �1l' I. for current year?
ty Yes ❑ No ,1tuderhar y ❑ 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 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.
Signature o ers full n-• e Date(month,day,year)
Full resident ad're 1l cnt(number and street,city,state,and ZIP code)
5542 South State Road 165, Owensville, IN 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)