HomeMy WebLinkAboutMortgage_Christy (3) „a•5i, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
i ':1 FOR DEDUCTION FROM ASSESSED VALUATION i I
State Form 43709(R12/6-14) Gibson atokED
„,,,; Prescribed by Department of Local Government Finance 1111'
INSTRUCTIONS: File
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To be filed in person or by mail. A Of��U 5PR 1 v
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 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. R •• order
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the count , r, _iki�r711itr
where the property is located during the twelve(12)months before March 31 of each year the deductio
See reverse side for additional instructions and qua lifications. uIB�• v COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Kee _ Kreig R.,shristygtid Pamela D. Christy
Taxing District Key number/legal description Record number Page number
Patoka 26-12-15-200-003.666-027 13btS- \M lIo
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 i,current year date of application legal or equitable owner?
82,000.00 E 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
Real Properly ❑ Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Commerce Bank
Address of mortgagee or contract seller(number ano street,city.stare.and ZIP code)
Name of assignee or other owner or holder of mongage
Address of assignee(number and street,cipt state.and ZIP code)
Does applicant own property in any If yes.what county? I What Taxing District? Has this deduction been requested If yes.state amount of deduction
other county '/' I on property for
in Indiana? ❑Yes G No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a ba lance 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 I 20 20 20 I
i 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/contract buyer of the aforementioned property on date application is filed.
Signal a(owner's full nar^e), Date(month,day.year)
R. c I yr, s
Full reside address of applicant(n bee and street.city.state.and ZIP code)
3031 E. Top Hat Rd, Princeton, IN 47670
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.