HomeMy WebLinkAboutMortgage_Deisher C•*o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
el` ` FOR DEDUCTION FROM ASSESSED VALUATION
� -
!.- State Form 43709(R13/10-15)
2017
��/ Prescribed by Department of Local Government Finance FI J 1
Y P �� H I ��/
INSTRUCTIONS:
To be filled in person or by mail. F rm f�1�d v(ith:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought DEC
❑ LU /
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 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ,I)( , - ounty Recorder
county where the property is located during the twelve(12)months before March 31 of each year t
deduction is sought.
eIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Devin S. Deisher and Katie A. Deisher
Taxing District Key number/legal description 26-11-31-300-004.243.021 /6195 W Record number Page number
Stalheim Ave., Owensville, Indiana 47665 ' ( S t 1 S
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?
5302,709.00 O Yes ❑ No
If no,what is his I 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
ID 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? Vvhat 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 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
iuowner Icontract buyer of the af.ementione_dd�(p\rope
/ter{ty on,date-a app�Iplicatf}10/1/1/4i —ioniisfiled.
full - - / \W�"�t 1 1� Date(mOnr�,day,meat)
136/1
Full resident address of applicant(numb d street,cat/state,and ZIP code)
6195 W Stalheim Ave., Owensville, IN 47665
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$10,000.