HomeMy WebLinkAboutMortgage_Elliott r,.^_iv STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
,�,�r�t�,,� State Form 43709(R12/6-14)
• 1/ Prescribed by Department of Local Government Finance
F1
INSTRUCTIONS: T ile I� '
To be filed in person or by mail. F •`+'1!1.191.
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 property([ 1 'County Auditor
located on or before January 5 of the immediately succeeding calendar year. JL P 1 t aunty Recorder
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 deduction is ht.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
SARA E. ELLIOTT GIBSON BSON COUNTY AUDITOR
Taxing District Key number legal description cot tu)ber Pa `` y1��Q
GL,Lis Y ,6-/q_ - in 3—C(o' c o- —C / t llO 1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of h.,ortgage/Contract indebtedness u id ass of the app6Cant the sole
March LSmt year ,.^ March 1,current year date of app i legal or equitable owner?
rG..yll� IVI,UX`/', IIIJJJ IZ1 Yes ❑ No
If no.what is lits/her exact share of interest? If owned with someone othef than spouse,indicate with whom
If name on record is different than that of applKxnt,indicate below: Is the property in question:Annuaey Assessed
IU Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
EVANSVILLE TEACHERS FCU
AdQrg55 pf� ge nt cweer(mum r aM stree fl Z7 9)A _ _Tic / r n
Name of assgnee`oroiherr owner or holder of mortgage ! V/�-/KI ylf 7 J
Address of assignee(number and street,city,state,and ZIP code)
Dces applicant own property in any If yes.what county? I What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes 151 No current year? ❑Yes 0 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 I 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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
owner I ntract buyer of the aforementioned property on date application is fled.
Si (a ' full time)n Qx II / j� / L Date(month,day,year)
l-L// `//6�/tom//l-lf/'`Y_ 09/14/15
Full resident address of applicant(number and street,city state,and ZIP code)
904 S . CENTER ST FT 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)
i
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.