HomeMy WebLinkAboutMortgage_Brundage (2)i
r w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun' "11`. ��t ear- --4 :,
FOR DEDUCTION FROM ASSESSED VALUATION �i�'
State Form 43709(Ri 1/6-09) 51 013
'- j Prescribed by Department of Local Government Finance M4! it O13
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INSTRUCTIONS: � �A�
To be filled in person or by mail. fi} . •
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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 GIBSON UNV 5utatt BTCQR
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
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)
Phillip Brundage and Monica Brundage
Taxing District Key number/legal description / 10237 South Quail Crossing, Haubstadt, Record number Page number
Indiana 47639 aL_ nn.3L-,Ia CB
4 _P , O(o(,'bo7.ck a n L 3 a co.S(.,
Assessed value of real property 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 leg I or equitable owner?
5168,000.00 f ii 'es ❑ 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 a property in question: Annually Assessed
eal Property Cl Annually Assessed
Mobile Home (IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Federal Credit Union
Address of mortgagee or contract seller(number and street.city,state.and ZIP code) ._-
6209 Vogel Road, Evansville, IN 47715 1 t p SY
Name of assignee or other owner or holder of mortgage _ - ,\O ,,.J•-***`C,*`
• a",c l
Address of assignee(number and street,city, state,and ZIP code) 1
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p. ,
Does applicant own properly in any other 'If yes,what county? 'What. Cal d n _..,property
county in Indiana? /� ([�
❑ Yes -Ne �,tek‘ eg ❑ Yes ❑ No
COUNTY AUDITC
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 penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
• pa dre(owner's full name) Date(month,day,ye r)
C y(-3 cs
ull resident address of applicant(number an treet,city,std,and ZIP code)
10237 South Quail Crossing, Haubstadt, IN 47639
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)