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1.1 s ' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ,'
�f r\ FOR DEDUCTION FROM ASSESSED VALUATION; f°;�1 ' # -
State Form 43709(R13/10-15) A -�' s , _' , iy, a a x Gibson' Patoka I'a• ,.....2018
a Prescribed by Department of Locel Gottenintent Finance', ,� A- ..
- 0 I. de Mark - k `
i INSTRucnoNS: ' 1- Cl2 orm filed wdh
z,,, To be filed in person or by titbit.? 47 •.:`r•_s l , ' } ,• 4 rp y, _: q .
• ] Filing Dates. 1)Real Property:Must be cornplated and dated in the calendar yearfor,g9kch t action is so , 0 .County Auditor
.y 16 ` t '=Must be filed or postmarked with the County Auditor•or County Reeccoardd6M ere the ❑ County Recorder' s'
- ',property is located on or before'January 5 of the immediately succeeding igt - ..r _«-
r ', t -2)Mobile/Manufactured Homes not assessed as Real Property.Must file with the - -1 _+ ' '• •r' .
i� , f%z `�` _county where thepropertyis locatedeurhgthetwelve(12)months before Marrh3lole the i + '•
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i* .y deductwm/ssought % .•< Y - /T ' s t„i
` See reverse side for additional insbuchons and qualfications. 1_ •J
•
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t.2 Applicant(owiteror aontraq.buyer;see restrictions on reverse side) - - : . 7" ,,,h.; 1 �-i
°Fred D. Kerstein:,Peg y S. Kerstein. .:-: ." - . .1'
i Taring Disebt d '- it.:"_,,,,,,r-. Key number/,legal desaiptlon 'r' ti number P number t ? 'l
Patoka .., . ,- : i, - i26-11,15-101.001:711-027. , . :r... : -i`:i _ o fig =: ; a-/o
.1: Assessed value of teal property as of: _ . Mortgage/Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Is the applicant the sole ` '
assessment date.current year 4'+;i 4 assessment date current year "': ca date of apptbon rF - „. - 4 Iegyfor equitable owner?
f.� 151,600 00:.. - •- _, ° - C. . . ' -69,000.00 k = R�Yes_ ❑.No:
II no.what la his l her exact share of Interest? .t " ., 0 owned with someone other than spouse.bdC late with wArom
i .`
,▪ -r I/name on record is ddrerent gum that of applicant,vindicate below: - • b tad piopeny in que54on:Annually Aemcewtl,. .
r + la'Real Property ' 0 Annually Ace-need
_ . .. . . Mobile Home(IC 6-1.1-7)
e : Name a mortgagee or onttabl saber + - ti - +_: � - fir -... is r 'k .
Mortgage Masters,of Indiana; ..
-y Address of mortgagee or contract seller(number and sheet city,state and ZIP code) -' • ,
#' 501 N. Cross Pointe Blvd; Evansville,IN 47715'> #,- r {1- •
Name ofassigneeor other ownerorholdsofnrtxt�e ;,,. Y {ij
- rS
Address a assgnee(number and street city state,and ZIP code) - - y_ ,: : .••
T
- : Does applicant own property in It yes,what k What Taring Dismaz Had this deduction been requested, Ifa yes state mount of deduction
"other county d r., ` r/�, st • onpmpertytor ,< r:_� :: :r ^+` :-a`'c .-
in Indiana? Yes . VM, .�/ ': anent yeah ❑Yes '❑No _ : .'-
• - A person is not entitled to this deduction unless the pe s a balance on the'person s mortgage or contract indebtedness that is recorded in the county 1 .t
/_' recorder's office(including any home equity line of credit that is receded in the county recorders office)that is the basis for the deduction ki s , j_ l .� > ;•.
„COUNTY_AUDITOR r� _• r .. - +.Y 7
ri _ - 1 • F a ,1 ,._ � _.: , it
y Dedugion approved in the amount 01:
sgn4d/ue a county AuMor,l ' . _ .. .Ca - - Date(month,day.yen ▪ .c r ,-
mry.;
c• ' 1/.We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant rs a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is fled. . _ r.s. ., S ._;_ - ,,. 1 .- i f y ".-, .
"' e( �en�s h�r9 n/orb/} •r -./}� ,/.�J Date(month day,year) t -
• i ��d/X( Y/ :C[.dJi[.b✓lr�(J r� ✓ _ ._ .. • .
� .ft'6 ��(0��8 '✓
F t address of applicant(number and street
701 S White Church Road, Prinn, IN, 47670 , : - , -, ' . , .
Person authorized by duly executed Power of Aanney or by IC 8-1 1 12-0 7 -. ,; Date(month day,year) , _ -t
' Address aaugw_dzed person(number andstreet`diy state:and ZIP code) - .M 1r. ' - t i_ .` Ev`
-1 ' 4 4 _,t., -� ,.,at eta cl' , -i_
,F , I _ .err., r • . IC . ..
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.4 :r:.1`; ,��`` -r. `r -`,