HomeMy WebLinkAboutMortgage_Potts ., 9, STATEMENT STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Wit FOR DEDUCTION FROM ASSESSED VALUATION
k -- ' 2015
�` State Form 43709(R12/6-14) r'I ';--'�1,
-:` '� Prescribed by Department of Local Government Finance u- t <, ',1 File Mark
INSTRUCTIONS:
To be filled in person or by mail. c DD 11 99Rn1c Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for Whictxtf dddf/dtion is sought. `r�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 9 County Auditor
property is located on or before January 5 of the immediately succee•' g cale gar - . County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Mu / -it.',t,•ty Auditor of the ,
county where the property is located during the twelve(12)rant• •9 .•=9 -!"'4*1ps!)g icRoror the
deduction is sought. li tl
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Chad W. Potts and Lad L. Potts
Ta ' Dist'et Key number/legal description /369 E Hirsch Woods Lane, Haubstadt, Record number Pa numbef,
Indiana 47639 aco-a3•(Sf_ aoo-ma.0a'4-oAV .: eir 393-5
Asse e value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtednest unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
$172,000.00 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
0 Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ---
Evansville Federal Credit Union _
Address of mortgagee or contract seller(number and street,city, state,and ZIP code) a° S -`3q 3�
6209 Vogel Road, Evansville, IN 47715 (I` l . ' `S Pr �/ /�0fDc _
Name of assignee or other owner or holder of mortgage L r— l ( ie
Address of assignee(number and street,city,state,and ZIP code) PO-H-5 Lac(
` �(errttyk
Does applicant own property in any If yes,what county? What Taxing District? Has Chi tic/ Ce '`�`
other county on property tor U own
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
Deduction approved in the amount of:
20 20_ 20 20 20 •20 20
Signature :f'ounty Auditor / / County Date(month,day,year)
I e 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 propert on date application is filed.
Signs ur (owner'sjuu name) `/ \ (i 1% `� Date(month,day,�aaQ
IQVC7 i I(,C,,:1J�,�' r7,\ � /v�ft / /!
II resident address of applicant(number and street,city,state,and ZIP code) /
369 E Hirsch Wood Lane, Haubstadt, IN 47639
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.