HomeMy WebLinkAboutMortgage_Hobson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R13/10-15) Fri- Jr Ft.Branch 2017
`• ? Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. AI��I((1111// 77 Lc� cc Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deri7�blrCn I£u i1.1B
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. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the county
where the property is located during the twelve(12)months before March 41 i( COUNTY AUDITOR t
See reverse side for additional instmctions and qualifications. li tfJ
Applicant(owner or contract buyer-see restrictions on reverse side
Beau M. Hobson � Vl“ c,�ieI -Lo05ay\
Taring District Key number l legal description R °r�d number Page number
Ft. Branch 26-18-24-202-000.718-026 dO I (.1 L if U
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?
$64,400.00 $76,250.00 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
Michael Hobson
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
TA Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
12626 US 41 N K63581, Evansville, IN 47725
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 y If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes No current year? ❑Yes El 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 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 pr erty on d- n is 'led.•
Sig .=cone/s I a,..) J(1 \ Date(•In ,da/yej r)�I�
IID. nt address• applicant(number and street,city,s te,and ZIP code)
08 S Cumberland Street, Fort Branch, IN 47648
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$10,000.