HomeMy WebLinkAboutMortgage_Bulens STATEMENT EMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
I
FOR DEDUCTION FROM ASSESSED VALUATION
xl' State Form 43709(R72/6-14) Gibson Patoka 2017
°; Prescribed by Department of Local Government Finance
INSTRUCTIONS: F1 pe ainlf
To be filed in person or by mail. o el
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 property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. JUL 14 ZIDIF�danty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is ught.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) GIBBON
Keshia M Bulens and Janis C F Bulens COUNTY AUDITOR
Taxing District Key number/legal description Record number Page number
Patoka 26-12-07-204-002.014-028 ao/(o 7-8 / 3
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?
44,000 58,814 a Yes ❑ 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
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
_Mortgage Masters of Indiana, Inc.
Aidress 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 —"
ably - aB 13 ta• 1C —
Address of assignee(number and street,city,state,and ZIP code)
Q. r . d io r`15 —
Does applicant own property in any If yes,what county? What Taxing District? Has this deduc \CAS `5�
other county on property for L+ `- c T b C1�r
in Indiana? ❑Yes ❑No current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or Cad Sk.e.-In S 4 sr( 714•b U
recorder's office(including any home equity line of credit that is recorded in the county recorder's office
_ 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/contract buyer of the aforementioned property on date application is filed.
Sign ture(owner's full name) n Date(month,day,year)
._ m RIB/v� %.AM 's (! i Rr i/etc q(.(_i I T z 0
Full resident address of applicant(number and street city,state,and ZIP code)
114 N Stout St., Princeton, IN 47670
Ferson 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)
Tne penalties for perjury can include imprisonment up to two and a half years and a tine not to exceed$10,000.