HomeMy WebLinkAboutMortgage_Moore (4) �o t,STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ Township Year
en 4 FOR DEDUCTION FROM ASSESSED VALUATION ) ,r
\ State Form 43709(R12/6-14) � "id
.1 '•-•I Owensville 2017
Prescribed by Department of Local Government Finance
INSTRUCTIONS: MAR 2 8 2016 File Mark
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 deduct' is sou ht.
Must be filed or postmarked with the County Auditor or County Recorder of the coun rty is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year R El county Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with et3SOkkeci4M) Nh&YQL
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Crystal M Moore
Taxing District Key number/legal description Record number Page number
Owensville 26-17-01-404-000.499-022 aokla \139
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,torrent year March 1,current year date of application legal or equitable owner?
40,200 43,701 p Yes O 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
IZ1 Real 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
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 ir/any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county N.JJ, 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.
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 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
(71.4„ " In m— 3-2Y'f6
Full resent address of applicant(number and street,city,state,and ZIP code)
506 N First St., Owensville, IN 47665
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street.nay state,and ZIP code)
The penalties for perjury can include imorisonment un fn hw and a half years and a fine not to exceed$10,000.