HomeMy WebLinkAboutMortgage_Halbig o-4.1",t4., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
id. _ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance t,�dc1
INSTRUCTIONS: Ile_�_
To be filed in person or by mail. HH formed •
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. nnn���
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propertj f$ y 1 , yp1 founty Auditor
located on or before January 5 of the immediately succeeding calendar year. �r�rounry 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 • .ht-.
See reverse side for additional instructions and qualifications. ( / �j'I►11��
Applicant(owner or contract buyer-see restrictions on reverse side) GI8SON COUNTY AUDITOR
Halbig, Kenneth and Shawnee
Taxing District Key number/legal description Record numlyr Page number
Patoka 26-12-16-100-000.074-027 raolS-- gC,.
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli the sole
March 1,current year March 1,current year date of application legal or eq table owner?
$ 99,000.00 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 mperty in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
501 N. Cross Pointe Blvd., Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dty,state,and ZIP code)
Does applicant own property in any If yes,what county? Wnat Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,--, property for
in Indiana? Yes ❑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:
21) 20 20 20 20 20 20
signature�of County Auditor�,,��.. County Date(month,day year)
I I We certify under the penalty of pe Lry that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/cont ct buyer of the afore -ntion property on date application is fled.
Signatur v er5 full name r Date(mtli,day,yeaQ
/U, 4. • fl 1- 20 J�
Full res• en dress of applicant it et. ,state,and ZIP code)
1945 State Roa• .• , Princ on, IN 47670
Person a orized by duly executed Power of Atto y or by IC 6-1.1-12-0.7 Date(month,day,year)
1
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.