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c—•o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,,°e`_ t FOR DEDUCTION FROM ASSESSED VALUATION
�i Slate Fomn 43709(R12/6.14) Gibson FTa gggg,1111 �n4
^,a,; Prescribed by Department of Local Government Finance
I
11_,/INSTRUCTIONS:
To be filed in person or by mail. Form tiled qwith:
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Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. S q• �r1�n�y lldilor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is
located on or before January 5 of the immediately succeeding calendar year. ❑ County cor
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile 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. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Casey Caringer
Taxing District Key number/legal description Record nu Der Pa e n rob r
Patoka 26-12-15-200-001.633-027 11
34 .
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?
146,300 180,612 EI Yes ❑ No
I 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
I7) Real Property ❑ Annually Accessed
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 Rd. Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,citty state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Dyes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
I 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 I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed.
.1 Signature(owner's lull name) Date(month,day,year)
9/11/2014
Full res '!�ynt(number and street,city,state,and ZIP code)
567 S. Cs ice Lane, Princeton, IN 47670
Person authorized by duty executed Power of Attorney or by IC 6-1.1-120.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.