HomeMy WebLinkAboutMortgage_Davis (22) _•^a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. Year
„d _ w FOR DEDUCTION FROM ASSESSED VALUATION
S; j• State Form 43709(R12'/6-14) .�; t 2016
'S Prescribed by Department of Local Government Finance -"- �IS�•
4M.
INSTRUCTIONS:
To be filled in person or by mail. Form -le• ' •'.
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 .❑ A
property is located on or before January 5 of the immediately succeeding calendar year. r�� �' •
' —van",•• ' •uditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of t IBSON r 0 tc T • ` Recorder
county where the property is located during the twelve(12)months before March 31 of each year the A t ��
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Lisa Kellems, Leonna R. Specht, Harold Leon Davis, and Deanna Fern Davis
ra ' g istri Key number/legal description 26-11-16-200-004.137-027/3985 W 75 S. Record umber_ Page number
Q Q Princeton, Indiana 47670 /U/ 15 OC
Assessed value of real rope 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?
$45,900.00 ❑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 property in question: Annually Assessed
❑ Real Property U Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Fo.1ar'rrr°dit Llnlnn _
Address of mortgagee or c
4401 Theatre Drive, E
Name of assignee or other i n.
Drawer NO.. . e1.4X
Address of assignee(num
Does applicant own prope,• Card NO. 151-4—: Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes f/- � ) �I1�' ecc current year? ❑ Yes ❑ No
`--� " �' 1. �'"� 1's mortgage or contract indebtedness that is recorded in the county
A person is not entitled tc
recorder's office(including any home equity fine of credit that is recorded in me 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/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 date application is filed.
S t `�Brame) Date(month,day,yeaD
Ful resident address of applicant(number and street,city,state,and ZIP code)
3985 W 75, Princeton, IN 47670
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.
a° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ji \-4,1,1 FOR DEDUCTION FROM ASSESSED VALUATION
. :
State Gibed 43709
Dee 2 meat FILED
•S ` Prescttbed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mall. Form Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the dedr i ou
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is Ng County Auditor
located on or before January 5 of the immediately succeeding calendar year. �t County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Co tie .q1./ny+;county
where the property is located during the twelve(12)months before March 31 ooffI Bach y: �:).r fir. r •-
See reverse side for additional instructions and qualifications. S,
Applicant(own.r. #tractb e: lion on erse side)
T. ' g is •/ Ak r Key num r//legal d p v ~ R rd nu bet Pa e
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1 r t ear date of application legal or equitable owner?
. 8ao ❑ Yes ❑ No
If no,what is his/her exact share of interest? f 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
.....- ......, . — ❑ Real Property ❑ Annually Assessed
' �' Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract sell •
Name of assignee or other owner or h ��• ...
Dra�t�r NO..........
Address of assignee(number and stye.
Card NO. ••••••
Does applicant own properly in any I 1 What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? Yes ID 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 County Auditor I County AlictiQ Date(monbd /
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/contract buyer of the aforementioned property on date application is filed.
Sig (owner's full name) Date( th,day,year)
� lQ�Il1Q- nu a•-� ._'._//G
Fu ident address of applicant(number a street,city,s te,and ZIP code) J f r
l Person authorized by duly 6-1.1-C124:0.7-111
7 executed Power of Attorney or by IC 6-1.1-12-0 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.