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HomeMy WebLinkAboutMortgage_Campbell (10) knot STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year SA ^ _ FOR DEDUCTION FROM ASSESSED VALUATION Air:• State Form 43709(R11/6-09) 1 51 2013 Prescribed by Department of Local Government Finance File Mark Sala INSTRUCTIONS: To be filled in person or by mail. AUG 9 2013 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 t'-prope is I. • X County Auditor on or before January 5 of the immediately succeeding calendar year. • ai 2)Mobile/Manufactured Homes not assessed as Real Property: Must fi{{��11���1 f q. g�1 ❑ County Recorder county where the property is located during the twelve(12)months beta& «�• h yb'd OR deduction is sought. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Matthew G.Campbell Taxing District Key number/legal description 1366 East Record number Page number Taftown Rd., Princeton, Indiana 47670 /3 26-12-05-400-001.439-027 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 legal or equitable owner? $120,000.00 O 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 Evansville Teachers Federal Credit Union Address of mortgagee or contract seller(number and street dN state antl ZIP code) i ��n / 4401 Theatre Drive, Evansville, IN 47715 D1'111'CI' NO ii/// Name of assignee or other owner or holder of mortgage �'I'p Address of assignee(number and street, city, state,and ZIP code) Ca I'd NO. 13 / 4a^i Does applicant own property in any other If yes,what county? Mat Taxing )perty county in Indiana? ❑ Yes No ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature ounty Auditor County 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/contract buyer of the aforementioned property on date application is filed. $ignyture er' fu name)r, /�' Date(montlLdSy,yeg� ley/ C1r (J//62/ II resident address of applicadd ber and street,city, state, and ZIP code) i 1366 East Taftown Rd., Princeton, IN 47670 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)