HomeMy WebLinkAboutMortgage_Lewis (7) r,. ,:.4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
atv,_, ppp{: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) 2013
S
\ Prescribed by Department of Local Government Finance I LIr
INSTRUCTIONS: MAY 21
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located • e!e in y Auditor
on or before January 5 of the immediately succeeding calendar year. B$ON ,
• •:ecorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of � OU A I • ;
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)
Tege E. Lewis and Tricia D. Lewis
Taxing District Key number/legal description 26-13-13-300-001.500-006/10845 E CR Record number Page number
100 South, Oakland City, Indiana 47660 1 •. .7ii C
' nnn esC
ooz nna 0 (3 .01c... �J
Assessed value of real properly as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
$160,000.00 AYes ❑ 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
Evansville Teachers Federal Credit Union 13,-3U5T
Address of mortgagee or contract seller(number and street city state and 7IP code) Drawer N O
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 ZIP code)
LQui s
Does applicant own property in any other If yes.what county? Who, .a..,,,y u„nucrr Has this deduction been requested on properly
county in Indiana? u J ` ' tt for current year?
pt Yes ❑ No 1'f.Gl ` A Yes ' ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County I Date(month, day,year)
I/We certify under 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.
ignature(owner's full e) • _.Date(month,day,year)
Full resident addre s of applicant(number and street,city,state,and ZIP code)
10845 E CR 100 South,Oakland City, IN 47660
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)