HomeMy WebLinkAboutMortgage_Clayton t+°:i;�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
de/ W \ FOR DEDUCTION FROM ASSESSED VALUATION
: 2017
y�_ pf State Form 43709(R13/10-15)
' %1x Prescribed by Department of Local Government Finance Y File Mark
INSTRUCTIONS: 111��� Y
To be filled in person or by mail. TT `@� Q 211 Form fled with:
f1�
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the dddl/cb1Sn is sought.
Must be filed or postmarked with the Cobnty Auditor or County Recorder of the county where th ❑
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 C�nl) 'tor t(18ttoR ❑ County Recorder
county where the property is located during the twelve(12)months before Marche each)y1earrttle
deduction is sought. G18S0N "�
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Gilbert T. Clayton
Taxing District Key number/legal description 26-20-28-200-000.046-001 /8406 E 900 S, Record number Page number
Elberfeld, Indiana 47613 a0 `1 - ({J c-1
Assessed value of real properly 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?
544,400.00 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 properly in question: Annually Assessed
0 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
other county on property for deduction
in Indiana? ❑ Yes 0 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 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 I contract buyer of the aforementioned property on date application is filed.
Si ature(ovine full - b) Date( onth dayar)
•Fulrres•- a••.. of number and street,city, state,and ZIP code)
8406 E 900 S, Elberfeld, IN 47613
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. .