HomeMy WebLinkAboutMortgage_Titzer (2) „,,--,..7,,,,q, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1 "}s FOR DEDUCTION FROM ASSESSED VALUATION a
1! _ Ip State Fonn 43709(R12/6-14) ] p J 2016
A9
'6� /� Prescribed by Department of Local Government Finance File Mark
ISM
INSTRUCTIONS:
To be filled in person or by mail. JUN 2 2016 Formrm f�th:
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, : county whe = the
is located on or before January 5 of the immediately succeeding �; •i County Auditor
property ry y 9 1,0 88 1” -y"VL1. .
2)Mobile/Manufactured n where the property is located not assessed the e Real Property:)m Mts 6b'e tii ��s -f i�tog�(the ❑ County Recorder
county where the property is located dudng the Twelve(12)months ttdd V
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kelsey A. Jace A. Blankenberger
Taxing District Key number/legal description 26-23-12-300-000.315-024/4501 E 1150 S, Record num r _ Page number
Haubstadt, Indiana 47639 030/ ait�
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I 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?
$146,600.00 'ryes ❑ 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
fit.Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller •
The Commerce Bank
Address of mortgagee or contract seller(number and street..city state,and 71P a car —
20 N.W Fourth Street, Evansville, IN A I/n^/ -/C9
'Name of assignee or other owner or holder a (-C — A�
Address of assignee(number and street,city, ����--DCCCC...raweP NO �)
Does applicant own property in any If' Card 1 O. •. jX./. q..... , duction been requested If yes,state amount of
other county . Y for deduction
in Indiana? ❑ Yes 'No _ ? ❑ 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 o unty Auditor 1 County ^ ) _ _ Date(month_day,year) ��
)1iL� � County
eglJKHMII\1 ap/�V1`P1
I I e ce ify under penalty of perjury t at a 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.
Si natle( ners full name),/ Date(month,day,year)a.
Full resident addess of applicant(number and street,city, state,and ZIP code)
4501 E 1150 S, Haubstadt, IN 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.