HomeMy WebLinkAboutMortgage_Benson en•^_n i STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION g
i', . State Form 43709(R12/614) GibSOF e 1:06nE,,,, Prescribed by Department of Local Government Finance Ye
INSTRUCTIONS: 1
To be Filing Dates:in person) a Property Must be completed and dated in the calendar year kx which the deduction is sought. JUL_L F L U I/
Must be filed or postmarked 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. ,, I. . .rder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the co f A �i
where the property is boated during the twelve(12)months before Math 31 of each year the deduct'�is s�4 '�. ��
See reverse side for additional instructions and qualifications. Ci I BSON COUNTY AUDITOR
Applicant(owner Of contract buyer-see restrictions on reverse side)
Cameron W. Benson
Taxing District Key number/legal description Record number Pa ^ember
Center 26-13-28-200-000.790-004 2,o t-1— a 9 S
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant me sole
March 1.anent year March 1.current year date of application legal or equitable owner?
118,825.00 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 appicant,indicate below. Is the property in question:Annually Assessed
El 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 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 apy If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? '�Q/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.
I 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.
Signor wnefs tub name) // /� Date(month,day,year)
an - (N. 1 g2.4044_ -7 l i t f ( 1
Full resident address of applicant(number and street,city,state,and ZIP code)
2915 S 850 E, Oakland City, IN 47660
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 S10,000.