HomeMy WebLinkAboutMortgage_Hillard z , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
/..V _y : FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R13 m0.15) L J
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: File Mark
To be filed 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 dedu /sQp1�h� f7
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Must be filed or postmarked with the County Auditor or County Recorder of the county whettitle drtl)1Hrty is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Co Auditor I t cou
where the property is located during the twelve(12)months before March 31 of eac ( is sought. --
See reverse side for additional instructions and qualifications. GIBBON nn Mr r
Applicant(owner or contract buyer-see restrictions on reverse side) U . .YRJDITOR
Hillard, Mike P
Taxing District Key number/legal description R rd num b rI
Haubstadt 26-19-31-301-000.197-009/Oriqinal Plan 93/94 Pt IO\i- qt,(
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness u aid as of Is the applicant the sole
assessment date,current year assessment date.current year date of application legal or eguita a owner?
76900 42000 116161.00 es ❑ 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 deferent than that of applicant,indicate below: Is"property in question:Annually Assessed
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First Liberty Financial Mortgage a division of Evansville Teacher Federal Credit Union
Address of mortgagee or contract seller(number and street.city.state.and ZIP code)
9520 Ormsby Station Road, Suite 20, Louisville, KY 40223
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 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 20 20 20 20 20 20
Signature of County Auditor County Dam(month,day,year)
I 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 I contract buyer of the aforementioned property on date application is filed.
,knatur ow efs 1u0 re ,fie(month,day,year)
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e r / \16-19-17
Ful silent addre s of pplicant(num rand street,city tale,and ZIP code)
369 V.,ve 57. /k0L/1Jf fN 979
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-01 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.