HomeMy WebLinkAboutMortgage_Bolton zeSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t FOR DEDUCTION FROM ASSESSED VALUATION
State Form 13709(R12/8-1 4) Gib 2017
,,,, Prescribed by Department of Local Government Finance l ;i -
INSTRUCTIONS:
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 deduction is sought.
APR ,,�.�.jfl�t
Must be filed or postmarked with the County Auditor or County Recorder of the county where the propertyls 2 ' L.S Vounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ® ,ou r Recorder
2) Mobile/Manufactured Homes not assessed es Real Property:Must file with the County Auditor of the cou 1 AM
where the property is located during the twelve(12)months before March 31 of each year the deduction is .l.r' ii•`n •
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Jason N Bolton
Taxing District Key number/legal description Record number - Page number
Ft. Branch 26-18-13-101-001.127-026 (to -1/MD /5q0
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?
131,300 141,455 p Yes ❑ No
If no,what is his/her exact share of interest? It awned 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
0 Real Proper Mobile me c❑S uaIly ss E1.1-7)
Name of mortgagee or contract seller - ✓ -
- taT-Ba SB seller „ rGk &5 d- T licrc,
Address Of mortgagee or contract seller(number nd street,city,state,and ZIP code) G�
Ft N Cross V0ke.3k J( sill xtte; rig g111�
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 yry/ 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 LLLJJJ 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 ' ” " . 1
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.
gnafu`e(owner's full name) Date(month day,yea /,,
Full r)(ident address of applicant(number and street,city,stalls and ZIP code) {{
7p2 Kennedy Dr., Fort Branch, IN 47648
Pels kin authorized by duly executed Power of Attorney or by IC 8.1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
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