HomeMy WebLinkAboutMortgage_Moss , .: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c%4 , FOR DEDUCTION FROM ASSESSED VALUATION
j State Form 43709(R13/10-15) Gibso Owensville 2017
Prescribed by Department of Local Government Finance TFa c�
INSTRUCTIONS: 1
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. NIL Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
NOV 3❑
Uty Auditor
located Manufactured n or before d January 5 of the immediately
essed as Real succeeding Property:c ustfile year. ❑ Con Recorder
2) Mobile/Manu/acfured Homes not assessed as Real Property:Must file with the County Auditor of the coup Af
where the property is located during the twelve(12)months before March 31 of each year the deduction is so
See reverse side for additional instructions and qualifications. GIBSON COUNTY Al iniTfla
Applicant(owner or contract buyer-see restrictions on reverse side)
Charles J. Moss and Ashley D. Moss
Taxing District Key number Reyap pprpber _ /alehurpberlr-
Owensville 26-18-07-101-000.068-022 /V�L�\/_�)`l l\!(l� /�f ((s/!Il `J
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?
72,500 100,000 p 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
O Real Property ❑ Annually Accessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address 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
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property i any 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 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 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.
Signature o efs full name) Date month,day,year)
Full resident aadr ss of applicant(number and street,city,state,and ZIP code)/
204 N Smith St., Owensville, IN 47665
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)