HomeMy WebLinkAboutMortgage_Fireline �a- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ;w gyp• r . Year
"t I FOR DEDUCTION FROM ASSESSED VALUATION _
l g State Form 43709(R13/10-15)
`- I �'
• �,";„✓ Prescribed by Department of Local Government Finance . Sr-
INSTRUCTIONS:
To be filed in person or by mail. Fo P. j.7
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 the property is ' 1 1 County Auditor
located on or before January 5 of the immediately succeeding calendar year. G/ . .4 .. .er
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the ZofXxp/C r+lljr•
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. O-•Alta.- -
See reverse side for additional Instructions and qualifications. - 'UDIjlR
Applicant(owner or con✓aot buyer-see restrictions on reverse side)
CHERYL A. FIRELINE
Taxing District Key number/legal description RecpatO! ?ytWpbr.r�r
26-22-12-303-002.307-024 /VY'/ )T ,Y^/� �/1���
Assessed vat.e of'e al property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appi<art the sole
assessment date,arrant year assessment date,current year date of application legal or equitable owner?
$172,000.00 ❑ Yes ❑ No
If no,what Is his I her exact share of Interest? It 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 .
Q Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
OLD NATIONAL BANK
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
ONE MAIN STREET, EVANSVILLE, IN 47708
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own proper, in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ( onpmpyea?
mlericon ❑Yes on property f ❑Yee ❑NO
A person is not entitled to 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:
I20_ I 20 20 - 20 I 20_ I 20 20
Signature of County Auditor I 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/canted buyer of the afor entioned property on date application is filed.
SI Ma ens fug name) I Date(month,day,year)
,, b,.- 09/15/2017
Full resident address of applican (number and street,city,state,and ZIP code)
11832 SOUTH 150 WEST, HAUBSTADT, IN 47639 .
Person authored by duty executed Power of Atromey or by IC 6-1.1-12-0.7 Data(month,day,year) .
Address of authorized person (number end 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.