HomeMy WebLinkAboutMortgage_King STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
= FOR DEDUCTION FROM ASSESSED VALUATION y�,t 1�
wt - •)1 State Form 43709(R12/6-14) b5J � N n t t 2017
�• �' Prescnbed by Department of Local Government Finance JJJJAL��� JJJhI NNN
INSTRUCTIONS: File Mark
To be filed in person or by mail. APR 6 21-! filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prop! is ! C aunty Auditor
located on or before January 5 of the immediately succeeding calendar year. ienli GU County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auc(igigg •= 1 •4 ,,TY
where the property is located during the twelve(12)months before March 31 of each year the e •
i M� - e
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Justin L King
Taxing District Key number/legal description Record number Page number
Owensville 26-18-07-101-000.515-022 ao l l acn
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?
93,600 88,271 ✓/
p Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom I
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
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 in ny If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
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.)
COUNTY AUDITOR
Deduction approved in the amount of:
20_ 20_ 20_ 20_ 20_ 20 I 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
wner/contract buyer of the aforementioned property on date application is filed.
ig ature wner's full name), Date(month,day,yep
Z- 1DS /1
Ful resident address of applicant(nu rid street,city,state,and ZIP code)
105 S Scott St., Owensville, IN 47665
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 810,000.