HomeMy WebLinkAboutMortgage_Sprinkle < t,.q. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ae' "V `s FOR DEDUCTION FROM ASSESSED VALUATION
!. 2015
a.
/• State Form 43709(R11/6-09) )
�s . Prescribed by Department of Local Government Finance FI L� 't "
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INSTRUCTIONS: •To be filled in person or by mail. JAN 1 'I. .r ".with:
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 ❑ ••my Auditor
,on or before January 5 of the immediately succeeding calendar year. ,,, ,q!±1j 11 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 yeRIA SON CO• •
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Larry D. Sprinkle and Ellen R. Sprinkle
Taxing District Key number/legal description 26-19-34-400-000.465-024/10133 S 350 E, Record number Page number
96frit4"-e)-2 Haubstadt, Indiana 47639
auk5 4(3
26-19-34-400-000.465-024
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?
$148,000.00 O Yes ❑ No
If no,what is his I 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 state and 7IP code)
711 Main Street, P.O. Box 360,Jasper, IN 47577
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 of County Auditor County Date(month,day.year)
I/We/We certify penalty of perjury t 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.
i natur ner'S tWf-namR ... ,,r / V C-15;),42-sale. Date(moot ,day, ear)
/b A !y _..) dJ( /Gv(0 y r ' Z r
resident ress of ap � t(number and street,city,sta ,and ZIP code) //
10133 S 350 E, Haubstadt, IN 47639
Person authorized by duly executed Power of Attomey 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)