HomeMy WebLinkAboutMortgage_Harte •^'�•v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS 1 Tnwms Year
14 FOR DEDUCTION FROM ASSESSED VALUATION nyAyay��w•• T i
i, i' State Form 43709(R13/10-15) 0,bsort -1. -AIBek 2017
•�' � Prescribed by Department of Local Government Finance .
INSTRUCTIQNS: AUG 2 O1e2016k
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.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prop t/' County Auditor
located on or before January 5 of the immediately succeeding calendar year. (r;; R S^1 N 9u wry Mcgotbt
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditd7 tllmiTtouriSry Recorder
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) .
Jordan Harte and Paxton Harte
Taxing District Key number/legal description Record number Page number
Mackey 26-20-14-301-000.004-002 - o2O ib 35!`�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date.current year assessment date,current year date of application legal or equitable owner?
28,400 34,858 0 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
Old National Bank -
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
1 Main St. Evansville, IN 47708
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 I on property for
in Indiana? ❑Yes IY 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 or:
. 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 pro perty on date application is filed.
ye(orMln � % DathY. ea ident add of applicant(number and street city,state,and ZIP wile)
7030 S Division St. Oakland City, IN 47660 -
Person authorized by duly executed Power ofAttomey 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.