HomeMy WebLinkAboutMortgage_Daniel /�s �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coul� ��� r• i�ir tear
i FOR DEDUCTION FROM ASSESSED VALUATION - I ;�!
yV• State Farm 43709(R13/10-15) ' ,
1._d
,,; Prescribed by Department of Local Government Finance �{ ��ff11
INSTRUCTIONS: FEB Fe M8rft18
To be filed in person or by mail. Form bled 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 propert, A v ounty Auditor
located on or before January 5 of the immediately succeeding calendar year GIRSOR! COUi't?I 1t i I Border
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile with the County Auditor o e county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. '
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Caleb S. Daniel & Daniele Daniel
Taxing Distri; Key number/legal description Record number Page number
c Cvcvrif 1 26-12-07-203-000.086-028 o �� s C
Ass sed value of real property as of Mortgage t 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?
$99,425.00 ❑ 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
❑ 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,stare,and ZIP code)
4405 Theater Drive P.O Box 5129, Evansville, IN 47716-5129
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 II yes,state amount of deduction
other county , property for
in Indiana? Yes 0 N 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 1 20 20 20 20 20
Signature of County Auditor County Date(month.day,year)
I I lNe 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.
Si,nature(owner's . ,a. 1 c D e(month.day,year
. ill 2"--5r/er
Full resident address of applicant(number and street.city.state.and ZIP code)
219 E State Street, Princeton, IN 47670
Person authorized by duly executed Power of Attorney 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 penury can include imprisonment up to two and a hall years and a fine not to exceed S10.000.