HomeMy WebLinkAboutMortgage_Rogers (2) ,.•vr•a• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
d� I;. FOR DEDUCTION FROM ASSESSED VALUATION
'4-'i 51 2013
t' State Form 43709(R17/6-09)
\- Prescribed by Department of Local Government Finance I q File Mark
\\\uu � Y HL ���ttI�JJJ 111Li'
INSTRUCTIONS:
To be filled in person or by mail. p pp pp 99((�� Form fit with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for ARic'h to @e(iPiF n is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located County Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must Auditor of the
county where the property is located during the twelve(12)mnin8'i9Nre gqroppeR the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jason Rogers and Christine Rogers
Taxi istrjety , Key number/legal description 26-19-19-203-001.264-026/155 E. 795 S., Record n bet Page number
cuff J Fort Branch, Indiana 47648 G/ll/Off
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a plicant the sole
March 1,current year March 1,current year date of application legal o equitable owner?
$136,800.00 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 t property in question: Annually Assessed
Is
Property ❑Annually Assessed
—-- _ _ _ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller - ---
Evansville Teachers Federal Credit Union Pe ak)eYS
Address of mortgagee or contract seller(number and stri Dra-1'V'er NO.S 410 (..,
4401 Theatre Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Card NO.
Address of assignee(number and street,city,state,and -
Does applicant own property in any other I7 Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes d No I I ❑ Yes ❑ No
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 un•- •-• . •f•- -ury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/cont -ct buyer of thee a sti _perty on date application is filed.
Signature(ow �� Date(month,day year)
Full resident addr; � _� • sheet city, state,and ZIP code) I
155 E 795 S, Fort Branch, 47648
Person authorized by duly executed Power of Attomey 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)