HomeMy WebLinkAboutMortgage_Martin (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
f�tt " State Form 43709(R12/6-14) Gibson Johnson I 2015
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: MafL
To be filed in person or by mail. 1g���lll Fonn r a wiu(■.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is OCT WY1y Auditor
located on or before January 5 of the immediately succeeding calendar year. oun y 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 sou j .
See reverse side for additional instructions and qualifications. P1711:
Applicant(owner r contract buyer-see restrictions on reverse side) G I BSO N COUNTY AUDITOR
Lynn L. Martin and Lori M. Martin
Taxing District Key number/legal description Record nnuu i� Page fluter
Johnson 26-23-16-100-002.005-024 "1 "/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 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?
246,400 200,000 ij 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
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
1 Main St. Evansville, IN 47708
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 If yes,what county? what Taxing District? I Has this deduction been requested If yes,state amount of deduction
other county ,—, property for
in Indiana? Yes 1 No current year'? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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/c'ntract buyer of the orem tioned property on d to application is filed.
ignat re,a rs full rl9 ,// Date(month,day year)
rnpp//f� � �' 0A , 10/6/2014
Full r. id: t address old F nt(numb rid street,dry,state,and ZIP code)
I0 S. Brooke Dr. Haubstadt, IN 47639
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.dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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