HomeMy WebLinkAboutMortgage_Hopster •
'it%
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13110-15) .
S Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: 1
To be filed in person or by mail. Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the property 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 County Auditor of the 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 reauiotluns on reverse side)
Hopster, Cree
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-19-18-301-000.425-026 aaCk — Q5
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,anent year assessment date,current year date of application legal or equitable owner?
$121,230.00 {) Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate belovc Is me property in question:Annually Assessed
❑i Real Property ❑ Annually Assessed
Name of mortgagee or contract seller
LED Mobile Home(IC 6-1.1-7)
Evansville Teachers Federal Credit Union 1p Address of mortgagee or contract seller(number and street,city state,and ZIP code) JAN 8 2U19
4401 Theater Drive, Evansville, IN 47716
Name of assignee or other owner or holder of mortgage
Add:ess of assignee(number and street,city,scare,and ZIP code) GIBSON (�,OUNT/ yAUp ilia---
Does applicant own property In any If yes,what county? Wnat Taxing District? oHas n property dedfuuction been requested If yes,stale amount of deduction
other county current year?r ❑Yes ❑No
in Indiana?a? ❑Yes CI 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 me amount of:
20 20 20 20_ 20 20 20
Signature of County Auditor County Date(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 resi ent of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
�S" to(y¢/, owners I✓ILaame) Date(rpo , tja I
tJ/ QaVVf� I7/
Full resident address of appf nt(num err and street,city,state,and ZIP code)
306 East'John Street, Fort Branch, IN 47648 Date(month,day,yea)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
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 310,000.