HomeMy WebLinkAboutMortgage_Kepple ,My�..n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4/ ' FOR DEDUCTION FROM ASSESSED VALUATION (�� ') 2022
,'. State Form 43709(R14/1-20)
� File Mark
'y� Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filled in person or by mail. For fi d with:
Filing Dates: Form 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 County Auditor
property is located on or before January 5 of the calendar year in which the property taxes ae first due
and payable. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Micah J. Kepple and Amy E. Kepple
Taxing District Key number/legal description 26-19-20-100-002.413-025/741 E 750 S Record number Page number
Fort Branch, Indiana 47648 0 2) 26-19-20-100-002.413-025 t-I2—/(1 //7
26-19-20-100-002.414-025
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the ap nt the sole
date of application le I equitable owner?
assessment date,current year
assessment date,current year $211,200.00 ❑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 p o yin question: Annually Assessed
PDRe Property 0 Annually Assessed
i�Name of mortgagee or contract seller Mobile Home(IC 6-1.1-7)
t41)
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Mq
501 N. Cross Pointe Blvd., Evansville, IN 47715 '�15 20
Name of assignee or other owner or holder of mortgage Gf9S
0e
Oqf`OU' . _ f
Address of assignee(number and street,ci ,state,and ZIP code) 'i-a-
1.1
Does applicant own property in any If yes,what county? What Taxing District? Has this dedtifdtipn been requested If yes,state amount of
other county on property for deduction
in Indiana? 0 Yes o current year? 0 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 thatkhe 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. Date(month, ay, ar)
Sign_ (owner's full namg) . ar 2--
L� //y
f
Fut resident address of appl nt(number and street,city,state,and ZIP code)
741 E 750 S, Fort Branch, IN 47648
Person authorized by duly 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)
T,_- _-......u:,,e fe-w-na iun.ran inclnrda imnri.cnnment iin in hero and a half waarc and a fines not to exceed$10,000.