HomeMy WebLinkAboutMortgage_Strobel env STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
? FOR DEDUCTION FROM ASSESSED VALUATION
3' l State Fonn 43709(R1216-14) tnohnson'.1
Prescribed by Department of Local Government Finance i f � ")
INSTRUCTIONS: ��1.11!-File Mark
To be riled in person or by mail. �IUN 1,6 rmfiled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough. Z t I/
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. ..,� ny Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of S
where the property is faceted during the twelve(12)months before March 31 of each year/ha • " t•~ �.
See reverse side for additional instructions and qualifications. U • • • TV AUDITOR
Applicant(owner a-contract buyer-see restrictions on reverse side)
Matthew L. Strobel and Jessica K. Strobel
Taxing District Key number/legal description Record number Page num
Johnson 26-19-31-400-001.029-024 t
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of s the applicant the sole
March 1,anent year March 1,current year date of application legal or equitable owner?
173520.00 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 Accessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First Security Bank, Inc.
Address of mortgagee or contract seller(number and street dry,state,and ZIP code)
313 Frederica Street, Owensboro, KY 42301
Name of assignee or other owner or holderof 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
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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's MI name) Date(month,day,year)
- G 8� • 06 /fiV /!7
Full resident address of applicant(number and street,city,state,end ZIP code)
177 E 1025 S, Haubstadt, IN 47639
Person authorized by duly executed Power of Attomey 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 810,000.