HomeMy WebLinkAboutMortgage_Rostron (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\9 FOR DEDUCTION FROM ASSESSED VALUATION G
a J State Form 43709(R13/10-15) l
'+.�_ -✓" Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: Form fi with:
To be filed in person or by mail.
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 ounty Auditor
County Recorder
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)
Rostron, James W. Reco number I Fagg nmb �
Taxing District I Key number/legal description ( r�
Haubstadt 26-19-31-301-000.449-009
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is
theapplicant
pll�i equitable owner?
sole
date,ae,current year date of application
assessment date,current year $230,000.00 Q 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 property in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED
MortgageeMastters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 N. Cross Pointe Blvd., Evansville, IN 47715 OCT )Z
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) 2,,A.r,I aJ ,/Q.,T'(14
Does applicant own property in any If yes,what county? I What Taxing District? Has this dedu
7 itYc l e'Smount of deduction
on property for
other county current year? Yes D No
in Ieriana? ❑Yes No
A person is not entitled 16 thig deduction unless the person has a balance on the person's mortgage r co act 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)tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20
I 20
I 20
I 20 I 20 I 20 20
'County Date(month,day,year)
Signature of County Auditor I r\`(\ \� ^w / G,� .o� i v�olq/ -
I/We certify under the penalty of perjury that the above a_nd�foregoiinnggtinfor fatiioon is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date app i 'Date(month,day,year)
Signature(owner's full name)���`�J � 10/21/2022
Full r ident address of applicant(number and street,city,state,and ZIP code)
302 North Race Street, Haubstadt, IN 47639 I Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
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$10,000.