HomeMy WebLinkAboutMortgage_Barrett (2) 1 4,-."„..,1,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
County Township Year
' � FOR DEDUCTION FROM ASSESSED VALUATION
k' S. i I. State Form 43709(Ri 1/6-14) IL 'I,) 2015
01��' Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: 2��5
-'-7o be filled in person or by mail. JUN 3 Form filed with:
'Filing Dates: 1)Real Properly:Must be completed and 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 coun where t•e �� ❑ County Auditor
} `. properly is located on or before January 5 of the immediately succeeding calendar r : —QOM, ❑
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Recorder
•i ' p rty: a t(• • Pf'7DITOR
county where the property is located during the twelve(12)months before A1.018DHf - --r the
deduction is sought.
''See reverse side for additional instructions and qualifications.
• Applicant(owner or contract buyer-see restrictions on reverse side)
William J. Barrett and Laura E.Williams
t Taxing District Key number/legal description 26-22-14-300-001.856-024/12894 South Record number Page number
Sunset Dr., Haubstadt, Indiana 47639
26-22-14-300-001.856-024 a O/ CJ a a 3 b
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?
} $213,400.00 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
1:
O Real Property ❑Annually Assessed
Mobile Home (IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union a 0
Address of mortgagee or contract seller(number and street,city, state,and ZIP cod D7- (S�
a) , -a
a ,4401 Theatre Drive, Evansville, IN 47715 w).C7-/�- a 3 -
( O
Name of assignee or other owner or holder of mortgage ^ � • •.�: 3`
- Address of assignee(number and street,city, state,and ZIP code) Card!` ,Y(1. Cl eq.y�(S•
. ra
�- jp••••. 1 U1 q •
I Does applicant own property in any 'If yes,what county? What Taxing District? ,` 11t yes,state amount of
other county on p,.. (,L deduction
in Indiana? ❑ Yes O No current year, r
• I.
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
'1-1/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
Itowner/contract buyer of the aforementioned property on date application is filed.
Si nature(owner's full name) Date(month,day,year)
3W % .>C--- s— aq— \5
Full resident address of app. n (number an street.city, state,and ZIP code)
12894 South Sunset Dr., Haubstadt, IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
t 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.