HomeMy WebLinkAboutMortgage_Wolak v..0051-4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�*: FOR DEDUCTION FROM ASSESSED VALUATION
}; State Form 43709(R13/10-15) • 2017
'� > Prescribed by Department of Local Government Finance J rk
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INSTRUCTIONS:
To be filled in person or by mail. AUG 3 two filed with:
Filing Dates: 1)Real Properly: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. ,1 1JJ�COunty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of '.',`4'fYt��"`^f^i't�l County Recorder
county where the property is located during the twelve(12)months before March 31 of eact jy� COUNTY AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Sean Martin Wolak
Taxing District Key number/legal description 261806303000380022/703 Water Tower Record number 'Paage number
Rd., Owensville, Indiana 47665 aoil-3a1Y
Assessed value of real property as of Mortgage I 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 legallo__r equitable owner?
$106,400.00 aYes ❑ 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 leathers 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 current year? ❑ Yes ❑ No
A person is of entitled to th 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 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 I contract buyer of the aforementioned roperty on date application is filed.
,61gn t e(owner' 11 name} Date(month day, ap
�r-'�_,,,c/ l c21e T at / 7
ull resident address of applicant(number and street,city,state,and ZIP code)
703 Water Tower Rd.,Owensville, IN 47665
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 Iwo and a half years and a fine not to exceed$10,000. .