HomeMy WebLinkAboutMortgage_Beuligmann / n _STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS =County— Township_
z} _ , --FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709(R13 1 10-15) Gibe LEI) 2017
� Prescribed by Department of Local Government Finance IL
INSTRUCTIONS: File ppMaii 17 •
To be filed in person or by mail. S E P 2 Norm111ed 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 ❑ CountyAuditor
located on or before January 5 of the immediately succeeding calendar year. NI I QAP.oun Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county 1T
where the property is located during the twelve(12)months before March 31 of each year the deduct(berri?sot)ghfr01- �i-�r -f'O •OR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Travis Beuligmann and Lexie Beuligmann
Taxing District Key number I legal description Record number Page number
Johnson 26-23-16-200-001.871-024 02 Olt q[� I
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?
208,400 70,000 0 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
12 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 Theater 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 deduction
other county on property for
in Indiana? ❑Yes o 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 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.
Signature(owner's u0n me) Da:e(month,.day,yea
r X
o q I a7� do 17
Full re Vent ent address ica t(number and street,city,state,and ZIP code)
2193 E Presley r, Haubstadt, IN 47639
Person authorized by duly executed Power ofAttomey 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 310,000.
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