HomeMy WebLinkAboutMortgage_Frederick "•n, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
°i FOR DEDUCTION FROM ASSESSED VALUATION
NtState Form 43709(R11/6-09) ���
s'6—'. Prescribed by Department of Local Government Finance
INSTRUCTIONS: +iD Irita!,.`
To be filed 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 deduction is sought. f?a�1 Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located f U Q CO W
on or before January 5 of the immediately succeeding calendar year. ' County 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.
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
JORDAN D. FREDERICK
Taxing District Key number-legal Vm ,teii CENTER TOWNSHIP 26-13-18-300-001.365-004
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 ,Yp legal or equitable owner?
$ 7./ 3the ,L IS Yes ❑ NO
If no,what is his/her exact share of interest? If owned with someone oer than spouse.indicate with whom
N name on record is different 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
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 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 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.
Sig .ure(. •es fun na'- Date( th.da.year)
/ I /2014
F•resident addre - pticanber and street. state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month.day,year)
5887 E. 115 S,FRANCISCO,INDIANA 47649
Address of authorized person (number and street.city,state,and ZIP code)
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