HomeMy WebLinkAboutMortgage_Gray (2) ^•tea STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a_--. .- FOR DEDUCTION FROM ASSESSED VALUATION
St l: State Form 43709(R12/6-14) 2018
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
File Mark
To be filed in person or by mail. MAR 2.1 2017 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 t .roperty is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. r,_ �� I ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Coug 14g• i , rr�- /
where the property is located during the twelve(12)months before March 31 of each yeti'.. ,n,-NI. .- DITaR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Matthew Q and Michele N Gray
Taxing Distnct Key number/legal description Record number Pagt�ggtbpl
26-10-36-101-000.888-021/ Lake Shore Estates Lot 136 & Pt. Lot 137 1 CJj)V
Assessed value of real proper•,y 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?
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
Mortgage Masters of Indiana
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? Mat Taxing District? Has this deduction been requested If yes,state amount of deduction
county nyear FA 3 000.00
in El Yes ❑No current year? Yes ❑No on
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 cert' under the penalty • •-rjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owne// •ntract b er of th- - entioned property on date application is filed.
g - - (• .2 5 0 - e) / Date(month,day,year)
/.� / 3/13/2017
FN - •-. addr. of applicant(number a sueet city,state,and ZIP code)
'.736 West 400 South, 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 310,000.
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