HomeMy WebLinkAboutMortgage_McKannan (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township �L J'Year
/a FOR DEDUCTION FROM ASSESSED VALUATION pg
�/' State Form 43709(R11/6-09) e
�,e,r 7 Prescribed by Department of Local Government Finance A J Fr
File Mark
INSTRUCTIONS:
To be filed in person or by mail. r t`, 4
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. �I, —!- ,q -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor o(3/lesn _ •'I
county where the property is located during the twelve(12)months before March 31 of each year the ■•r • - DITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kevin R. McKannan
Taxing District Key number/legal description Record num�` , Page number
FRANCISCO 26-13-19-202-000.171-005 14- I"1 f"1i
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?
0.); GI Yes ❑ No
If no,what is his 1 her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is deferent than that of applicant,indicate below. Is the property in question:Annually Assessed
ri Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
HAUBSTADT STATE BANK
Address of mortgagee or contract seller(number and street,cry,state.and ZIP code)
803 E STATE HWY 68, HAUBSTADT IN 47639
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 properly
county in Indiana? for current year?
❑ yes El<lo ❑ 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.
Signature( w !s full name) Date(month,day,year)
Full r ident address of applicant(number and street,city,state,and ZIP code)
304 S First Street,Francisco,IN,47649
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)