HomeMy WebLinkAboutMortgage_Ellermann �9 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township _ Year
leis x%_ FOR DEDUCTION FROM ASSESSED VALUATION 2017
s State Form 43709(R13/10-15)
!a Prescribed by Department of Local Government Finance IL I Il.krk
ono
INSTRUCTIONS:
To be filled in person or by mail. MAo 2 ,I .tr filed 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 located on or before January 5 of the immediately succeeding calendar year. •,i ounty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of th-', :/^17' . my Recorder
county where the property is located during the twelve(12)months before March 31 of each year the_ • ' �•
deduction is sought. GIBSON COU
See reverse side for additional instructions and qualifications.
(owner or contract buyer-see restrictions on reverse side)
Andrew J. Ellermann and Tara L. Ellermann
Taxing District Key number/legal description 261117400001784021 /1346 S Old State Record number Page number
hr • Road 65, Princeton, Indiana 47670 PT" /3j 9
Assessed val;- of real p so-rty as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment(ate,current -ar assessment date,current year date of application leg or equitable owner?
$207,300.00 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? What Taxing District? Has this deduction been requested If yes,state amount of
other county L. /'� on property for deduction
in Indiana? )9Yes ❑ No ( � current year? es ❑ No 9)0 U
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 penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/ tract buyef th orementioned property on date application is filed.
ggitatu (o s full n e) Date(month,day,year)
Full resident a dress of pplicant(number and street,city,state, and ZIP code)
1346 S Old State Road 65, Princeton, IN 47670
Person authorized by duly executed Power of Attomey 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.