HomeMy WebLinkAboutMortgage_Leary �0_.rA STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. Year
„k_ o _ \s FOR DEDUCTION FROM ASSESSED VALUATION 2015
S� _ _ s` State Form 43709(R11 /6-09) -
' � `i4, Prescribed by Department of Local Government Finance _ ,I il: Mar•! l
/1116
ii
INSTRUCTIONS:
To be filled in person or by mail. "^fi S..+ it
i915
Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. L 5
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. ,'�l ■' i • ,, ;-corder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the GIa$O lki,attr?Ry'r
county where the property is located during the twelve(12)months before March 31 of each year the .1.1N-1-%,
deduction is sought. TY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Robert A. Leary
Taxing District Key number/legal description 26-17-12-202-000.203-022/206 South Third Record number Page number
a Street, Owensville, Indiana 47665
ajeACC2)///f� 26-17-12-202-000.203-022 dais �0?2
Assessed value of real property as of Mortgage I 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?
$77,350.00 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
O 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.ON state and ZIP bride)
4401 Theatre Drive, 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,wha --- i`"a°t Taxino District? _ Has this deduction been requested on property
county in Indiana? /1 — ---..—^.nt year?
❑ Yes 0 N k-CR' o� rr „ y,�,,, 1 ,•. n ❑ Yes ❑ No
Deduction approved in the amount of: """L S. I a l 1...�
20 20 20_ (J 20_ 20
I I
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/contract buyer of the aforementioned property on date application is filed.
Signa]we-(rny nets ull/came U ryh da
` of
/F I resident address of app (num street,city, state, and ZIP code)
206 South Third Street, Owensville, IN 47665
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)