HomeMy WebLinkAboutMortgage_Nix Q STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
gN 2015
State Form 43709(R11/6-14) - B �.l Prescribed by Department of Local Government Finance gggg JJJiii File Mark
INSTRUCTIONS: MAY 8 2015
To be filled 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.
Must be filed or postmarked with the County Auditor or County Recorder of the county whe the• ❑ County Auditor
I property is located on or before January 5 of the immediately succeeding calendar year. TY AUD TOE County Recorder
1 2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the Geypistt01643
county where the property is located during the twelve(12)months before March 3roT each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jennifer A. Nix and Charles William Nix
Taxing District Key number/legal description 26-19-31-304-000.370-009/506 East Haub Record number Page number
Street, Haubstadt, Indiana 47639
26-19-31-304-000.370-009 20 l S / 7 9 3
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?
$92,000.00 O Yes ❑ No
It 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: '-••in Question: Annually Assessed
"-•n'rally Assessed
6_1_1-7)
Name of mortgagee or contract seller Or;a 1 ��
Community State Bank of Southwestern Indiana 1 0I NO S
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) • ••.•
11201 Upper Mount Vernon Road, Evansville, IN 47712 Card N0 " //r
Name of assignee or other owner or holder of mortgage • •_ ..1.•�• ,
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes (i No current year? ❑ 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 certify under 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 pro erty on date application is filed.
Si a owner's-MI name Date(m ay, ear)
1071, (7- A *hi Iltom.: C 7' G 7- 5'�
Full r 'dent addiE6s of applicant(number and street-61y, !fate, and ZIP code)
506/East Haub Street, Haubstadt, IN 47639
Person authorized by duty 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 S10,000.