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Home My WebLink AboutMortgage_Walden At___/°�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _ : FOR DEDUCTION FROM ASSESSED VALUATION •'• State Form 43709(R12/6-14) Prescribed by Department of Local Government Finance i INSTRUCTIONS: e ark To be filed in person or by mail. . Filing Dates: I) 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 is ^nn❑-,Fo4PA'dwditor located on or before January 5 of the immediately succeeding calendar year. Hf Il❑ oLuotyl 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 sought. See reverse side for additional instructions and qualifications. •)l.{�i[ Applicant(owner or contract buyer-see restrictions on reverse side) GIBBON COUNTY AUDITOR SCOTT WALDEN Taxing District Key number/legal description Reford number Page number FORT BRANCH 26-19-18-303-001.180-026 cg) I LQ I t258 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 of appti atio•0.I �-t legal or equitable owner? I�y3f l 1, ❑ 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 ddterent than that of applicant,indicate below: Is the property in question:Annually Assessed GI Real Property ❑ Annually Ac•ecsed 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) 4401 THEATRE DRIVE, EVANSVILLE, INDIANA 47716 Name of assignee or other owner or holder of mortgage Address of assignee(number and street,dry,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes 0 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 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 owner I contract buyer of the aforementioned property••d-te application is filed. Sig atu - (•. / Date(month,tlay, ear) Li' ..- ✓✓i/ //LI 02/ �L /2016 F ' rcNent dress of applicant(number and suet:city,state,and ZIP code) 102 N. WALTERS STREET, FORT BRANCH, INDIANA 47648 Person authorized by duly executed Power of Atomey 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. � ,,,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year >t_ - i FOR DEDUCTION FROM ASSESSED VALUATION Sascribeaay Department of' Prescribed by Department o7 Local Government Finance a 1I INSTRUCTIONS: F 111 tie ark To be fled in person or by mail. Fling Dates: I) 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 is A RR❑ f oyrtiy,Atrdrtor located on or before January 5 of the immediately succeeding calendar year. Hf n❑ oCCunVvy�t 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(72)months before March 31 of each year the deduction is sought. See reverse side for additional instructions and qualifications. ��'! A.ptic-ant(owner brconwad buyer-see resmcions on reverse side) GIBBON COUNTY AUDITOR SCOTT WALDEN 'lazing Distia Key number/legal descnp;ion Reprd nurmier Page number FORT BRANCH 26-19-18-303-001.180-026 cLQ 109 I g 53 Assessed value&red property as of Mortgage/Contract indebtedness unpaid as d Mortgage/Contract indebtedness unpaid as of Is the appiicam me sole Mardi 1,current year March 1,=Tent year da: of pplira:io „rl legal or egirvde owner? 1 3X13 • 0 Yes 0 No If no,what is his/her exact share of interest? II owned with someone other than spouse,indite with whom If came on recac is dCerent than cut&appfran,indicate below: Is the property in question:Annually Assessed 0 Real Property ❑ Annually Assessed 9 Mobile Home(IC 6-7.1-7) Kara&mono agee or contract seller - _ _ Pi/h/ /{�/ ��e / Address of mortgagee or contract seller(number and sweet city.sate.and ZIP code) . . : — 1 — — • n . • • a s • .1, . Named assignee or other owner or holder of mortgage 475 OP-St61.107 Address&assignee(number and wee&dry.state,and ZIP code) IDoes applicant own property in any If yes,rata:county? NTat Taxing District? Has this deduction been requested If Yes,stare amount&deduct n airier count' on property for in Indiana? ❑Yes ❑No current year? ❑Yes 0 N 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 ding any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction. f COUNTY AUDITOR Deduction approved in the amount of: 20_ 20_ 20 20_ 20 20 20 Signature of Court"),Auditor County I 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 owner I contract buyer of the aforementioned property •-date application is filed. Sq. W (•... _ _ Date(month.day. ear) X L,///j� / --� _ -02/—xL /2016 • • colt••rats of appbant(number and snee,.dN.state,and ZIP code) 102 N. WALTERS STREET, FORT BRANCH, INDIANA 47648 Person authorized by duly executed Power of Acorney or by IC 0-1.1-12-0.7 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.