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�•°r 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
S, /� State Form 43709(R12/6-14) 2016
\ ✓ Prescribed by Department of Local Government Finance FI a k
�!am
INSTRUCTIONS: {1��
To be filled in person or by mail. P I rr2 fld2M6
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 is located on or before January 5 of the immediately succeeding calendar year. Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ��ppttvv rder
county where the property is located during the twelve(12)months before March 31 of each year the GIBSON C[7UNTY" UU1
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Brittany Lynn Weinzapfel and Ryan Matthew Weinzapfel
T "" District Key number/legal description 26-23-18-100-002.547-024/269 W 1200 S, Record number - Page number
Haubstadt, Indiana 47639 01(n I 570
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?
$139,000.00 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 properly in question: Annually Assessed
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _-
Evansville Teachers Federal.Crodit('-°--
Address ofmortgag ______-__.-----
4401 Theatre o /�
Name of assignee e o 02 O/
Drawer NO.......
Address of assignee• I
Does applicant own p •...••• rict? Has this deduction been requested If yes,state amount of
other county CUI NO on property for deduction
in Indiana? ❑ Ye: -. current year? ❑ Yes ❑ No
A person is not entitle '• - _ ..a.,a valance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office finch.......4 any name 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 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 property on .ate ap.lication is fled.
i•n.tu_re(owner's full name) j \/ 11": Date(montA, ay,year)
S.o t -1.1 a J.1L. 7� ��
Full resident addt"s of applies nt i ' ber and street,city,sta T and ZIP code)
269 W 1200 S, aubstadt, 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.