HomeMy WebLinkAboutMortgage_Campbell 4 STATEMENT FOR DEDUCTI OON F MORTGAGE FROM ASSESS OR CONTRACT ED VALUATION
INDEBTEDNESS Coun Townshi. Year
,�> State Form 43709(R71 /6-09) _ 2014
%-,____--, Prescribed by Department of Local Government Finance ' _ F r
HIM .INSTRUCTIONS:
To be filled in person or by mail. r
j
F de with:
Filing Dates: 1)Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. SEP f
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. ty 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) , OOU
deduction is sought. NTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Clint J.Campbell and Megan M. Campbell
Taxing District Key number/legal description 26-22-03-100-000. 024/2990 West Record se-.375
number Page number
State Road 68, Haubstadt, Indiana 47639
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?
$200,000.00 tW'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 the property in question: Annually Assessed
'l-Real Property ❑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
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? Mat Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes 1,1KPNo ❑ 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 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/ of act buyer of the aforementioned property on date application is filed.
rgnat n f fu Q44tne) Date(month day,year)
► 7—11—)21
Full r sident address of applicant(number and street,city,state,and ZIP code)
2991 West State Road 68, 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)
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Clint J.Campbell and Megan M. Campbell Evansville Federal Credit
Date filed(month,day,year) Amount of indeMMnfv