HomeMy WebLinkAboutMortgage_Hensley (2) C STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) 7ggg�' 2016
DUL R File Mark Prescribed by Department of Local Government FinanceT�Subject�e fin�F t f ns(er
INSTRUCTIONS: day o tl�n
To be Dates:in person Property:email. Form filed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the edu t n s L Qom/
Must be filed or postmarked with the County Auditor or County Re 4 per of th d.._rp ere the Auditor
property is located on or before January 5 of the immediately sun- ,:4: z'r3•'?r'lV. . . °_, n coon County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the L' - ?e t4(�}1e tY ❑ County Recorder
county where the property is located during the twelve(12)montarndenifiSON3C014441YeAlialTOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Roy A. Hensley and Peggy L. Hensley
Ta`��+nq9�District Key number/legal description 26-17-12-204-000.436-022/ 106 E Walnut 'Reco��mper Page ey-1
A ill St., Owensville, Indiana 47665 P 0O✓
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?
$92,300.00 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 property in question: Annually Assessed
2 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)
.. I
. -..
Drawer NO... �Does applicant own property in any If yes,what county? 'VJha - If yes,state amount of
other county deduction
in Indiana? ❑ Yes 2 No //�� ••-..- 1
Card \O. ....... ..1.l.
A person is not entitled to this deduction unless the person has a balanc _.---..-at is recorded in the county
recorder's office(including any home equity line of credit that is recordei .. ..._ _..,.,.,r,mwruers office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature only uditor County Date(month,day,year)
e certify under penalty of perjury tha t grove and foregoing information is true d correct and that the applicant is a resident of Indiana and
owner/contract bu er of the aforementioned property on d pplication is filed. ;
Ka tore owner's full ame) /� Date(month y,year)
esiden address of applicant(Aumber and street,city,star , ZIP�i€)r
106 E Walnut St.,Owensville, IN 47665
Person authorized by duty 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 halfd a half ve `'cad'0,000.