HomeMy WebLinkAboutMortgage_Runau °'°o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7 ��`. FOR DEDUCTION FROM ASSESSED VALUATION 2016
S`- I State Form 43709(R12/6-14) FILED��""""��
'ems i/ Prescribed by Department of Local Government Finance {!J R LED File Mark
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INSTRUCTIONS:
To be filled in person or by mail. ' Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for 4111.0 ti4 decga4yt is sought.
Must be filed or postmarked with the County Auditor or County Recoriler'of the county where the ❑
property is located on or before January 5 of the immediately succeedin calendar year County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file ith th uditor of the ❑ County Recorder
county where the property is located during the twelve(12)months be ch r he
deduction is sought. GIBSON COUNTY AUDITORR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kelly J. Runau and Joshua L. Green
Taxing District Key number/legal description 26-14-18-302-000.751-007/219 W Record number Page number
0 a.."--12-4-v-of Washington St., Oakland City, Indiana 47660 i Co I ( 7
Assessed value of real prop 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?
$71,979.00 >aes ❑ 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
dal Property - O-Anna--.-
_ ) 7
Name of mortgagee or contract seller ", ^ - , 1' •.1Q_j .7)
Mortgage Masters of Indiana Inc. (L'1 �(Y^ L _
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /�,nn 1 1 I 1 P
501 N Cross Pointe Blvd, Evansville, IN 47715 1 -� _ —
Name of assignee or other owner or holder of mortgage I^! UM
I W
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has thi: ,_ ....�. I If yes,state amount of
other county on prop_.,, Ito deduction
in Indiana? ❑ Yes ❑ po current year? ❑ Yes ❑ No
A person is not entitled to lb. deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorders 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: 4 -
20 20_ 20 20_ 20 20' 20_
Signature of County Auditor County Date(month,day,year)
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Spnatur (` nrflf/ullll name) Dr)te(month,daa year)
Full r " adddrreees5 of applicant(number and street,city,state, and ZIP code) e'`� 777(e
Full
219 W Washington St.,Oakland City, IN 47660
Person authorized by duty 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.