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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
.���' Court Township Year
;VII FOR DEDUCTION FROM ASSESSED VALUATION
qT State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance •
:Fi • : -. IF
INSTRUCTIONS:
To be filed 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. 11 II ,,��((11
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propert)JIJN 2 9 L (ibunty 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 coup x
where the property is located during the twelve(12)months before March 31 of each year the deduction is �_'•.t.' .1,. :•See reverse side for additional instructions and qualifications. '`1F
Applicant(owner o contract buyer-see restrictions on reverse side)
GIBSON COUNTY A,. . x
Patricia A.McDonald
Taxing District Key number/legal description Record number Page number
Owensville 26-17-01-403-000.056-022 IS-alutDS
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 I,current year date of application legal or equfrable omer?
106,500.00 p Yes ❑ No
If no,what is his/her exact share of interest? t 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 Property ❑ Annually Amassed
Mobile Home(IC 64.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city.state.and ZIP code)
1 Main Street, Evansville, IN 47708
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,sate.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 deduction
other camty ,,,J, on Property for
in Indiana? ❑Yes Ill No current year? ❑Yes iii 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 I 20 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
o e-/contract buyer of the aforementioned property on date application is filed.NAL
S- mat- ( • erS lull n� e, yjd I Dave(month.day,year)
1 6-9141C
all resident address of applicant(number and street city.state,and ZIP code)
206 Crestview Dr., Owensville, IN 47665
Person authorized by duty executed Power of Attomey or by IC 6-1.1-12-0.7 I 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 tine not to exceed S10,000.