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„ �1 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County = ip I Year
i ' '1E, FOR DEDUCTION FROM ASSESSED VALUATION
1E State Form 43709(R12/6-181 I
� � Prescribed by Department �- ,7
�„� y partment of Local Government Finance
INSTRUCTIONS: F art r •
To be filed in person or by mail.
jai Form der w, '.
Filing Dates: I) Real Property Must be completed and dated in me calendar year for which the deduction is sought. n
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 4 Jn//11L'I,�.�. C un uditor
located on or before January 5 of the immediately succeeding calendar year. _I
ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of theQJtl$'QN
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. AUDITOR
See reverse side for additional instructions and qualifications.
pplicant(owner or contract buys-see restrictions on reverse side)
KALA M. KNAPP
Taxing District Key number/legal description Record number Page number
FT BRANCH 26-19-18-301-000.383-026/TRETTER PK 2p6 13/
Assessed value ci real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sale
March 1,current year March 1,current year date of application legal or equitable owner?
107,500 103,500 E 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 COMMERCE BANK
Address of mortgagee or contract seller(number and street,city.state,and ZIP code)
20 NW 4TH ST EVANSVILLE IN 47708
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state.and ZIP code)
Dces applicant own property in any If yes..Nat county? What Taxing District? Has this deduction been requested (If yes.state amount of deduction
other county on property for
in Indiana? ❑Yes 0 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.
COUNTY AUDITOR 1
Deduction approved in the amount of:
20 20 20 20 20 20 20
I
Signature of County Auditor County I Date(month,day,year)
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/contr buyer of the aforemention roperty on date ap cation is filed.
oat (owns' firllfl ,_ / w / Date(month,day.year)
�{//J�f (�•/ 01/02/2015
Full resident add ss of applicant(number and street.city.sta a ZIP code)
601 E. JOHN ST. FT. BRANCH, IN 47648
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 I Dare(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 510.000.