HomeMy WebLinkAboutMortgage_Segal d •^era` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Tow. Year
9
FOR DEDUCTION FROM ASSESSED VALUATION 1
�� State Form 1?709(R12/6-14) 6 2017
.5 Prescribed by Department of Local Government Finance -
INSTRUCTIONS: q 6)
To be filed in person or by mail. AUG I+z Form tiled with:
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 ounty Auditor
located on or before January 5 of the immediately succeeding calendar year. ' - Co�tglecerder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
�UtJ7Y VU
where the property is located during the twelve(12)months before March 31 of each year the dedts(i tb .
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Robert Segal and Rachel Harvey
Tatting District Key number/legal description Rei d number Pa number
Union 26-19-19-400-022.019-025 61 qSD
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant a sole
March 1,current year March 1,current year date of application legal or equitable owner?
349,500 380,000 p 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
Evansville Teachers Federal Credit Union Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
4401 Theater Dr. Evansville, IN 47715
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own properly in y If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on properly for
in Indiana? Yes No current year?
ID ❑
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/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.
Signnesty rp(owners t 1 name) (' A Date(month day,yeah
u^� erne) /�Lt-C,1:� "-' rr 8 l)9 ALP
FuU resident address of applicant(number and street.city,state,and ZIP code) /
8225 S Hidden Lake Dr. Ft. Branch, IN 47648
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.