HomeMy WebLinkAboutMortgage_Bedell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township I Year I
tt FOR DEDUCTION FROM ASSESSED VALUATION
I
lea State Form 43709(R12/6-14) I Gib �( I 2016
YPrescribed by Department of Local Government Finance 11
INSTRUCTIONS:
To be filed in person or by mail. I Form filed witn:
..Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JUL 1 1
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. n County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the•i.1. •
where the property is located during the twelve(12)months before March 31 of each year the d��tSpG��"L'i. '�h'ri:
See reverse side for additional instructions and qualifications. V •UNTY AUDITni2
.Abolican;(owner or contract buyer-see restrictions on reverse side)
Dustin P Bedell •
Taxing District
Union Key number/legal description
26-19-08-200-000-079-025 •/ Record numoer/5 SOC
Page numoer
( �
Assesses value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mixon 1,Current year March 1,current year date of application legal or eouimble owner?
179,300 199,975 / D Yes ❑ No
I If no.what is his/her exact share of interest? If owned with someone otner than spouse.indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assesses
Gl Real Property ❑ Annually Accessed
First Robinson Savings Bank, N.A. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
501 E Main St., Robinson, IL 62454
.I Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
I Name of assignee or other owner or noloer of mortgage '
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 demotion been requested If yes,state amount of a_cuaion
other county on 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.
I 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 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_
nat r owne rs rrrII name) f (1 day,year)
Clt�\✓ 11j111 7/10/2015
ult resident address of applicant(numbel and Ireet.city,state,and ZIP code)
g
5894 South 10I0E, Fort Branch, IN 47648 I Date(month,
I Person authorized by duty executed Power of Attorney or by'IC 5-1.1-12-0.7 Date(month.day year)
Address of authorized person (numoer and street,city state.anc ZIP code)
The_nennIlint for penury can include imprisonment up to two and a half years and a fine not to exceed 510.000.