HomeMy WebLinkAboutMortgage_Ballard a/ a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;t FOR DEDUCTION FROM ASSESSED VALUATION
'IC? ��
State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be lied in person or by mail. JUN 2 9 £815 with:
Filing Dates: 1) Real Property: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 county where the propert is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. / • i A - ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the CountyAuditor of the 7 n:.. -1011,10;
where the property is located during the twelve(12)months before March 31 of each year the 431$5Nb}NTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ballard, Roger A. & Lana K.
Taxing District Key number/legal description Record number Page number
Patoka 26-12-06-100-004.518-027/Pt NW 6-2-10 .97Ac 15- dcA55/'
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 egma neR
140,100.00 134,715.00 138,000.00 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: Is the perry in question:Annually Assessed
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)
4405 Theater Dr., P.O. Box 5129, 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 prpettji in any I` sr hat county? What Taxing District? Has this deduction been ested If yes,state amount of deduction
other county on property for
in Indiana? es ❑No btySG current year? es ❑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
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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
o - .. . t buyer of the aforementioned property on date a.plication is filed.
S nature(owner's f name) / Date(month,•-y,year)
A t
Full resid:nt add'applicant(number arm street,city,state,an•ZIP code)
Person authorized by duty 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.