HomeMy WebLinkAboutMortgage_Hart (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•° = FOR DEDUCTION FROM ASSESSED VALUATION
6 State Form 43709(RU/6-09) Gibson Owensville 2015
. j Prescribed by Department of Local Government Finance
To
INSTRUCTIONS:fledi person J l w '
To be filed in person or by mail.
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought.
Must be tiled with the County Auditor or County Recorder of the county where the properly is located IN County Auditor
on or before January 5 of the immediately succeeding calendar year. JULCJ CNItt Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. of
See reverse side for additional instructions and qualifications. �'tyty
Applicant(owner or contract buyer-see restrictions on reverse side) CICCON COUNTY AUDI IUK
Bradley J. Hart
Taxing District Key number I legal description Record number . number
Owensville 26-18-07-100-000.144-022 / — AP 65
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1.current year date of application legal or equitable owner?
65,900 57,400 n 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
O Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bancorp
Address of mortgagee or contract seller(number and street,city,slate,and ZIP code)
711 Main St. Jasper, IN 47547
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 O No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature f C `
County Date(month,day,year)
J „..41-12
..4 -
I 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(owner's lull name) Date(month,day,year)
6An ,1b kb-22f; 6/25/2014
Full resident addr of a licant(number and street,city,state,and ZIP code)
434 E.Walnut St.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)