Mortgage_Reed (2) ^�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
} moo. County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
S'ky State Form 43709(R12/6-14) � 2016
� a Prescribed by Department of Local Government Finance M
ram
INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. Form
9�
Must be filed or postmarked with the County Auditor or County Recorder of the county where the r'U 72�
property is located on or before January 5 of the immediately succeeding calendar year. f;'6unty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the CountyAuditor of the ❑ C n Recorder
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. GIBBON
See reverse side for additional instructions and qualifications. - COUNTy AUntrOR
Applicant(owner or contract buyer-see restrictions on reverse side) -
Erik S. Reed and Alisha L. Reed
Taxing tni / Key number I legal description 26-23-01-200-002.106-024/10520 S 525 E, Record number Page number
Haubstadt, Indiana 47639 , Instrument
s ed value of real prope as of Mortgage I Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is e i gttle
ch 1,current year March 1,current year date of application legal or equitable owner?
VVVV $231,600.00 ❑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 ❑Annually Assessed
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, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state, and ZIP code)
Does applicant own property in any If yes,what county? Mat Taxing District? Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes ❑ 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 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
��`o��`������ffffffner/contract buyer of the aforementioned Ploperty n date application is filed. r/�o
Siiature own is full name) x � v'_` . Date(l G ry,��/af°
Full))resident address (number and street, city,`state, and ZIP code) l
10520 S 525 E, Haubstadt, IN 47639
Person authorized by duly executed Power of Attomey or by IC 61.1-12-0.7 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.