HomeMy WebLinkAboutMortgage_Haley (2) ,. '•o STATEMENT'OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
kv.• ' FOR DEDUCTION FROM ASSESSED VALUATION -- -
`3�` /, State Forth 43709(R12/6-14) 2016
• Prescribed by Department of Local Government Finance File Mark -.--
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INSTRUCTIONS: 'I
vgp th.- i i
Txbe filled in person or by mail. • "E_Jr - oanfil with: _
Elting Dates:1)Real Property:Must be completed and dated in the calendar year for which the der'uction is sought.Must be filed or postmarked with the County Auditor or County Recorder of the county where
property is located on or before January 5 of the immediately succeeding calendar year. F L . 10 2016 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the - ❑ County Recorder --
county where the property is located during the twelve(12)months before March 31 of each y:ar the
deduction is sought. 4 id
See'reverse side for additional instructions and qualifications. • U7A1".
Applicant(owner.or contract buyer-see restrictions on reverse side) t,lbbON COUNTY I.UCITC°
Kelly P. Haley and Lori A. Haley
Taxing District - . Key number/legal description 26-18-36-403-000.154-009/545 W State Record number Page number
. Road 68, Haubstadt, Indiana 47639 01.0 1 (0 5/0
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 1,current year date of application legal or equitable owner?
5150,130.00 Wes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
1
If name on record is different than that of applicant,indicate below: Is the property in question: Annually Assessed -- -
eal Property ❑Annually Assessed --
Mobile Home(IC 6-1.1-7) -
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc. �_ -
Address of mortgagee or contract seller(number and street,city, state,and ZIP code)
501 N. Cross Pointe Blvd., Evansville, IN 47715 a'O `�° b
Name of assignee or other owner or holder of mortgage "Ce l l y ', C._ L6 r i (`1
Address of assignee(number and street,city,state, and ZIP code) N q-`G(V iik o (�'\t (-,S
( n�' `` Mlo�sT«S)
Does applicant own property in any If yes,what county? What Taxing District? H; .� I-3 nt of
other county O1 I S O 13 o, O U
in Indiana? ❑ Yes o a t 2.- \o- 1 J L+
A person is not entitled to t is deduction unless the person has a balance on the person's mortgage or contract.,ti,..,.__.. aunty
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 o C. nty Auditor. /.,I . . County Date(month,d year)
Wertify under penalty of perjury that the above and foregoing in ormation is true and correct and that the applicant is a resident of Indiana and
Owner/contract buyer f the aforementioned property on date application is filed.
(o 'errs Lull n >e 6 I Dale(month day,y or)
Full r de t address of applicant(numb nd street,city, state, and ZIP code)
545 W State Road 68, Haubstadt, I 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)