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Mortgage_Reinbrecht (5) •m, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS a County I Township I Year .. i FOR DEDUCTION FROM ASSESSED VALUATION S State Form 43709(R12/6-14) Gibson Haubstadt r.1 Prescribed by Department of Local Government Finance lie !©,, INSTRUCTIONS: To be filed in person or by malt. Form filed with: Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought.CCp n Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly i9 L 0 I W County Auditor located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Properly Must file with the County Auditor of Ill- county where the property is located during the twelve(12)months before March 31 of each year the deduct l g . - ••4 .j See reverse side for additional instructions and qualifications. • TI MM. Applicant(owner o contract buyer-see restrictions on reverse side) etssotteoutarrAuntrar Kenneth W. Reinbrecht and Rhonda A. Reinbrecht Taxing District Key number/legal description Reyerdnumber Page vn r Haubstadt 26-23-06-101-000.325-009 r`//(u�n )L12, /VJI t�K^ Assessed value of real property as of Mortgage/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 equitable owner? $80,000.00 p IYes ❑ 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 Q Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Evansville Commerce Bank dba Commerce Bank Address of mortgagee or contract seller(number and steer,city,state,and ZIP code) 20 NW 4th St. Evansville, IN 47708 Name of assignee or other owner or holder of mortgage • Address of assignee(number and steel,city,state,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 county ,—, property for in Indiana? Yes 2 N 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 I 20 20 20 20 Signature of County Auditor County Date(month,day.year) I/We - Ty under e pen. r •f pe• ' that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/•• tracts' er of re •- tioned property on date i filed. • S j L /J Date(month.Jai/Ma ' 014 Q 016 F • resident address of ap.ica •ber and sweet,city,state,and ZIP code) 407 S. Bradley Dr. 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.