HomeMy WebLinkAboutMortgage_Koch (3) CSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�tsq FOR DEDUCTION FROM ASSESSED VALUATION
A/I' State Form 43709(R13/10-15) Gibson Columbia 2018
• Prescribed by Department of Local Government Finance
ow. File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates:1)Real Properly:Must be completed and dated in the calendar year for which the deduction is sought 0 County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the ❑ County Recorder
property is located on or before January 5 of the immediately succeeding calendar year.
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Karl G. Koch , Kelly Rae Koch
Taxing District Key number/legal description Record num r P ge,��yym
Columbia 26-13-12-100-001.494-006 20l �1.6
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is th pplicant the sole
- assessment date,current year assessment date,current year date of application I or equitable owner?
134,000.00 208,000.00 Yes 0 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 property in question:Annually Assessed
Real Property 0 AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name ofmortgagee seller 1'T J
First Federal Savings Bank
Address of mortgagee or contract seller(number and street.city,state,and ZIP code) ,.� J
2200 W Franklin St., Evansville, IN 47712
Name of assignee or other owner or holder of mortgage DEL 4 Anti
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in ap( If yes,what county? What Taxing District? Has ttG kBeBbbhCeeJ.r4iested u%-IplkQBate amount of deduction
other county / on property for
in Indiana? ❑Yes L7 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 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.
Signature(ow r'`l name) �J Date(month. ay.year)
Q
.- h 1 4 i 14dI J") Vi(�r� i/ 2l//0
Full resident a dress of applicant(number and street,city,state,an ZIP e
10693 E 50 N, Oakland City, IN, 47660 a
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.