HomeMy WebLinkAboutMortgage_Davis Jr r 4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ems` \: FOR DEDUCTION FROM ASSESSED VALUATION
�7 State Form 43709(R12/6-14) 2016
\i"" ry Prescribed by Department of Local Govern r D $t- , f�l�N File Mark
ais
INSTRUCTIONS: to fin. c-.1: ce or r
To be filled in person or by mail.
ta y f r���,r�, , Form filed with:
Filing Dates: 1)Real Property:Must be completed and de ca -•.., y-- •1.y' ;- n is sought.
Must be filed or postmarked with the Coun •uditor or Cou Re.. der of the county where the 0
property is located on or before January M he im .14:_ ..--eding - dar year County Auditor
2)Motile/Manufactured Homes not assess-- s'•' ' :-*' "1q!'' 1 ;••. !' ' c County Auditor of the 0 County Recorder
county where deductions souehropertyis located during =t 4�`NTY Milt/.each year the
sought AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Richard A. Davis Jr.
Taxing District Key number/legal description 26-12-08-203-000.009-028/1808 Taylor Record number Page number
Ave. Princeton, Indiana 47670
070/ (0 )-& g
26-12-08-203-000.009-028
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year dale of application legal or equitable owner?
$100,000.00 O Yes ❑ No
If no,what is his I 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
O Real Property 0 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 /,,
• Of a1Yer NO..1 t 7�(l
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? I• Card nio /' of
other county • ..-f� IL.CC�/�/
in Indiana? ❑ Yes ID No Icurrm..,___ .
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness um.._.- inty
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_
i ar)
Signaler o nty'Audit4 �. /) County Date(month,day,year i i D� to
O
I/We certify under natty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract y of the aforemention property on date application is filed.
SlgrIC( nee u is � Date(month,day,year)
Ful resident address of applicant(numbe nd�et,city, state,and ZIP code)
1808 Taylor Ave., 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 Iwo and a half years and a fine not to exceed$10,000.