HomeMy WebLinkAboutMortgage_Caniff era STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 =_ ! FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R12/6-14) Gibson Columbia 2016
• Prescribed by Department of Local Government Finance
FA
INSTRUCTIONS:
To be filed in person or by mail. - Eowith:
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 proof-ED 2 5 ,:059 County Auditor
located 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 •unty
where the pro I
property is located during the twelve(12)months before March 31 of each year the deductio ;•
sought_ -
See reverse side for additional instructions and qualifications. �'Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COL,rv; ; AUDITOR
Colt Mitchell Caniff
Taxing District Key number/legal description Red number ber Page nytn5
Columbia 26-13-23-101-001.168-006
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?
94,700 155,039 p 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
Acceptance Capital Mortgage Corp. 0 Real Property ❑ obilelHome(ICC6-1.1-7)
Name of mortgagee or contract seller
101 Plaza East Blvd Ste 103, Evansville, IN 47715
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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? 'Meat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year?
El ❑
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 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
I•wner/contract buyer of the aforementioned property on date application is filed.
y u -(.;n-r's full name) Date(month,day,year)
Tom` 2/20/2015
Full resident a••ress of applicant(number and street,city,state,and ZIP code)
1915 Whispering Hills Rd.. Oakland City, IN 47660
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.