HomeMy WebLinkAboutMortgage_Pray�� ^ n„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
� FOR DEDUCTION FROM ASSESSED VALUATION
j'�'� 51 2012
�j �+ State Fortn 43709 (R71 / 6-09)
�:�� Prescribed by Departmeni of Local Government Finance 110��
INSTRUCTIONS:
To 6e �l/ed in person or by maiL Forp� filed with:
Filing Dates: 1) Real P/opeRy Must be complefed and dated in fhe calendar year for which the deduction is sought. � N�r ]3
Must be (led with fhe CountyAuditor or County Recorder o/ the counry where fhe property is located �� �OGbunty Auditor
on or befo2 January 5 o(the immediately succeeding calendar year. ❑ un ecorder
2) Mobile /Manufactu2d Homes nol assessed as Real Property: Must file wifh the County Avditor o7the
county whe2 the propeRy is bcated dunng the hvelve (72J months before March 31 0l each year the
deduction is sought. GIBSON COUN7Y AUDITOR
Applicant (owner o� mnt2U buyer- see resfictions on reverse side)
Gregory D. Pray
�/�/�-�
number / legal description 26-18-07-101-000.208-022 / 105 Rock Road
ensville, Indiana 47665
, �, _�00.208-022
nssessed vawe oi rea� property as ot MortgeBe / GOnV2ct 6
March 1, current year March 1, curteni year
$104,500.00
ii no, whai is his / her exaa share oi interest?
If name on rewrd is diRerent than lhal of a00ticant, indicale below:
Name of mortgagee or conVad seller
Evansville Teachers Federal Credit Union
Address of mortgagee or contracl seller (number and street. ciN. siate.
4401 Theatre Drive, Evansville, IN 47715
Name oi assi4nee or other owner or holder of mortaaoe
appficani own pmperry In any
y in Indiana?
❑ Yes
cUon approved in the amount �
20 20
20 _
as
appliW�on
someone
��/� /9
t indebiedness unpaid as ot Is the apPlicant the sole
legal or equitable owneR
� Yes ❑ No
han spouse, inCicale wilh whom
he property in question: Mnually Assessed
Real Property ❑ Annually Assessed
.���..�.
��( �� .. /..... rtYean
DI'8\1'C'��.........�. —
Cai•d 1'O . .....................
(month,
►'�
on Property
r�
I/ We certify under penaliy of perjury that the above and foregoing information is true and corred and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
i- amra�(mvners Iull name) � Date (montA, pay, yea�
strcet, city, state.
105 Rock Road, Owensville, IN 47665
or
person