HomeMy WebLinkAboutMortgage_Risinger (3) ,.•°w'•q. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e `'t FOR DEDUCTION FROM ASSESSED VALUATION
}�" • State Form 43709(R12/6-14) 2015
�, Prescribed by Department of Local Government Finance 1 r
INSTRUCTIONS: A
To be filled in person or by mail. • • M ti;61I h:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the ❑ ounty Auditor
property is located on or before January 5 of the immediately succeeding calendar year. I • c aunt Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of eiIBSON �m7l�r y
county where the property is located during the twelve(12)months before March 31 of each year the AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ryan P. Risinger and Carol S. Risinger
Taxing District Key number/legal description 26-22-12-300-002.320-024/1397 West Record number Pa gQ numl t
Cloverdale Court, Haubstadt, Indiana 47639 15- 9 LE 'U(
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a cant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
$195,500.00 0 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 the property in question: Annually Assessed
li Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
PO Box 918, Evansville, IN 47706
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 If yes,what county? That Taxing District? Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes )0 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:
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 I contract buyer of the aforementioned property on date application is filed.
Signatdrie owner'���{{Jull name) • to(month,day,year)
Full resident address of applicant(number a street,city, state,and ZIP code)
1397 West Cloverdale Court, Haubstadt, IN 47639
Person authorized by duly 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$10,000.