HomeMy WebLinkAboutMortgage_Holcomb (2) s.•°1 c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi. Year
th 4 FOR DEDUCTION FROM ASSESSED VALUATION 2017
�� State Form 43709(R131 10-15)
So_. Prescribed by Department of Local Government Finance g
,•n• LED
INSTRUCTIONS: I
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. JUN V
1 f C x017
filed Must be 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. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the /dun❑ _county Recorder
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Brian L. Holcomb and Kassi L. Holcomb
Taxing District Key number/legal description 26-11-15-101-003.652-027/2687 W Jill Dr., Record number� LJ
P7rluaybgr`—�
Princeton, Indiana 47670 96 �XU
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
5203,958.00 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
l 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 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 I 20 20 20 20 20_ 20_
Signature of County Auditor County Date(month,day,year)
I/We certify under penalty of perjury pat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contra buyer of the afo - . -ntioned property on date application is filed.
ie a(owner-full nom=/ Date(m nth,day,}par)
.s � ckc1 N 9 �qLo hiLL ( .jI
' Full •-dent address of applicant(number and street,city, state, and ZIP code)
2687 W Jill Dr., Princeton, IN 47670
I 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 half years and a fine not to exceed$10,000.