HomeMy WebLinkAboutMortgage_Silva STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
S• �� State Form 43709(R11/6-09) Gibson UNION 2015
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: TgTTTggg.... HHHVVVVH....
To be Dads:person by mail. rrn�
Filing Dates: i) Real l 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 oun y u l or
on or before January 5 of the immediately succeeding calendar year. £onty,frpcorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 1 r7 L U 17
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. /)
See reverse side for additional instructions and qualifications.
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Applicant(owner or contract buyer-see restrictions on reverse side) G I BSO N COUNTY AUDITOR
JAMES G.SILVA
Taxing District Key number/legal description Recwa'rjym ' picr
UNION TOWNSHIP 26-19-13-200-002.259-025 �y/�/�Ul `C/./
Assessed value of real property as of Mortgage I 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?
328,800.00 314,000.00 249,495.00 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
GI Real Property ❑Annually Assessed --
w.
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
FIRST NATIONAL BANK OF CARMI
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
201 E. MAIN ST., CARMI, IL 62821
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 0 No I Yes EtNo
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
1 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.
Signet e(owner' lima Date(month,day, ar)
/�. c/7/ic
Full esidem address of applicant(number and street,city,state,and ZIP code)
(R38 5 500 E Fr-i" 8rahc,4. IN W 7&YS)
Person authorized by duty executed Power of Attorney or by Id 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street.city,state,and ZIP code)