HomeMy WebLinkAboutMortgage_Pegram (6) ^,,a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
• FOR DEDUCTION FROM ASSESSED VALUATION n� �^ yv�bnT�Dr/te �j
t I/l State Form 43709(R13/10-15) X11 L.L7c1 2C'�I Ib'
\ % Prescribed by DepartmeQt of Local Government Finance I o
INSTRUCTIONS: �FfMar� J)
To be fled in person or by mail. rr Nti�le1
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 JUL 7 ❑.,G }gnty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ IfoffuJ)nty Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sour' . .
See reverse side for additional instructions and qualifications. I r' et
GIBSON COUPJTY Ai In'T0p
Applicant(owner or contract buyer-see restrictions on reverse side)
James P. Pegram , Kelly L. Pegram
Taxing District Key number/legal description Record number Page number
Montgomery 26-11-31-300-004.696-021 'a0 `i - a5 '�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appIi t the sole
assessment date,current year assessment date,current year date of application legal o stable�s'ner?
276,000.00 297,730.00 Yes LJ 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 property in question:Annually Assessed
Real Property ❑ AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal
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,ny If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county r--,( on property for
in Indiana? ❑ 0 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 fine 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 I 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 bu er of the aforementioned property on date appi7li is filed.
Signature(o• nee /I e) Date(month,day,year)
Full resid nt address of a icant(number and street.call,sta and ZIP code)"
6398 W Stalheim Ave., Owensville, IN, 47665/
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 perjury can include imprisonment up to two and a half years and a fine not to exceed 810,000.