HomeMy WebLinkAboutMortgage_Monroe Y o . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
I
3, State Form 43709(R11 /6-14)
} .
I�l
s�_i.� Prescribed by Department of Local Government Finance F "-
INSTRUCTIONS: •
To be filled in person or by mail. Fo - , • •
Filing Dates: 1)Real Property:Must be completed end dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the Ch},Q{tditer
property is located on or before January 5 of the immediately succeeding calendar year. �)!t-.�LL . Arp1L..ecorder
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 the GI: - : • • • •- • • it -
.
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Matthew A.Monroe �({I�n)�q�'
Taxing District Key number/legal description /4 West Red Bank Rd., Fort Branch, Reeafddn Im� Pagl]v 1
Indiana 47648 VV��`r11 }`
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?
$71,900.00 ❑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: Q /� / Is the property in question: Annually Assessed
a to - 18-a 4-a oa -VVD• 01 l d Q -V d v ❑ 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,city,state,and ZIP code)
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 If yes,what county? What Taxing District? Has this deduction been requested if yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes ❑ No current year? ❑ 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/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) • no, Date(month,day,year)
art! Gun
Full resident address of applicant(number and street,city,state,and ZIP code)
4 West Red Bank Rd., Fort Branch, IN 47648
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.