HomeMy WebLinkAboutMortgage_Fouts EEatSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�'t FOR DEDUCTION FROM ASSESSED VALUATION
I 2015
x` ,x State Form 43709(R11 /6-14)
. S"" <l Prescribed by Department of Local Government Finance File Mark .
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INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Property'Must be completed and dated in the calendar year for which the uc' g
Must be filed or postmarked with the County Auditor or County Recorder of the county where the t County Auditor
property is located on or before January 5 of the immediately succeeding calendar year)II N 015 ❑ County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the Coun udit r of t e
• county where the property is located during the twelve(12)months before March 31 of each year the
deduction d io naunht. g �/./f
See reverse side for additional instructions and qualifications. pM� •tf
Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR
Josh A. Fouts
Taxing District Key number/legal description 26-12-05-400-000.286-027/ 1234 East Record number Page number
Taftown Rd., Princeton, Indiana 47670
/ iib,i? /.• 5 a 26-12-05-400-000.286-027
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?
$109,250.00 9''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
.Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
• Evansville leathers Federal Credit Union ao45
Address of mortgagee or contract seller(number an Drawer NO
4401 Theatre Drive, Evansville, IN 47715 ey I C� `7
. Name of assignee or other owner or holder of mortg (�Card
(�N O. O1( (7
Address of assignee(number and street,city,state, � Tyd rl' _� V . •
icr
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 No current year? ❑ Yes ❑ No
I/ r
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day.year)
.r 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 he aforementioned property on date application is filed.
azure(owner's full full name) pQa�atte(month,day,year)
Full resident address of applicant(number and street,city, state,and ZIP code) I\
1234 East Taftown Rd., Princeton, IN 47670
Person authorized by duly executed Power of Attomey 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.
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