HomeMy WebLinkAboutMortgage_Price II STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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a w FOR DEDUCTION FROM ASSESSED VALUATION' �Qp��
!-Cr State Form 43709(R11/609) T / R i I
— Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
-�_ To be filed in person or by mail. j •• i 'led 1,
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
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. - I .1111�'
; , — nty Recorder
2)Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the J y'
county where the property is located during the twelve(12)months before March 31 of each yer3n gesso N • • • - • • • • -
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
JAMES PRICE, II A
Taxing District Key number/legal d T Record number Page number
MONTGOMERY TWNSHP 26-17-29-400-003. -021 /26-17-29-400-004.700-021 /4-13 9
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,anent year date of application legal or equitable owner?
$ 87/ 387. 00 O Yes ❑ No
If no.what is his/her exact share of interest? If owned with someone btrrer than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Fl Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
ACCEPTANCE CAPITAL MORTGAGE CORPORATION
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
101 PLAZA EAST BLVD., SUITE 103, 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 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 21 No ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20_
Signs re /County Auditor / County Date(month,day,year)
I/We certify under the penalty o'fl perjury that ttthe 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.
Sig Lure(owner's hull name) Date(month,day,year)
a St1:_.-�-}- 05/ lc, /2014
Full r dent address of applicant(number and street.city,state,and ZIP code)
10895 W.925 S,Poseyville, Indiana 47633
Person authorzed 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)