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•.. °').c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION.: ,
State Fonn 43709(R12/6-14) '3.7; [:!1?v;l-: -26•
s s: .-..y
.20(B
Prescribed by Department of Loral Government Finance '..� '1L:. ici-:�'tci (1!:041 ! _ -
1 - t:
INSTRUCTIONS: -- I G.rii! ��--File`Mark
To be filed in person or by mail. (2;Cc ,Id ,2iF:tiei!5': ' , Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought. FEB U 1 /I!it
Must be filed or posbnarked with the County Auditor or County Recorder of the county where the property is u County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the coun,�/tyY. • r ■r/i` • ' Recorder
where the property is located dung the twelve(12)months before March 31 of each year the deduction is sor7ght. ni ' IP'
See reverse side for additional instructions and qualifications. GO3Sf-r, COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Joshua and Laura M. Auxier
Taxing District Key number/legal description R nunr P umber
26-18-13-404-000.152-026/Old Plan Lots 24, 25 and Pt. 23 J 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 a pllca legal or equitable amen
Ex r� ❑ 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
E) Real Property ❑ Annually Assessed
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 in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for 3 000
in Indiana? ❑Yes ❑No current year? 17 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 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owners full name) Date(month,day,year)
Full resident address of applicant(number and street city,state,and LP code)
101 South Main Street, Fort Branch, IN 47648
•,P1rsor>auth by duly e,retuteq aowpr otAt:omey or by IC 6-1.1-12-0.7 Date(month,day,year)
'Address off a/Ihodz\_ed /n um e/ f 1r'�1 7
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 510,000.