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d��• 41 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,�, FOR DEDUCTION FROM ASSESSED VALUATION
,f State Form 43709(R13/10-15) 2019
\� 1 Prescribed by Department of Local Government Finance ' e ark
•,• JL
INSTRUCTIONS:
To be filed in person or by mail. AR 2filed with:
Fling Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought 9 mg
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the 0
property is bcated on or before January 5 of the immediately succeeding calendar year. ounty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must tie with the County Auditor of t •CCCounty Recorder
county where the property is boated during the twelve(12)months before March 31 of each year
deduction is sought GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Appicant(owner or contract buyer-see restrictions on reverse side)
Jason Bradbum and Melissa Bradburn
Taxing District Key rumba/legal description 26-13-13-300-000.166-006/ 1206 S 1075 E. Record number Page number
CDLUMegrn Oakland City, Indiana 47660 Q/�01 i^
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as o Is the applicant the sole
assessment date,current year assessment date,anent year date of application legal or equtable owner?
S103,785.00 ❑Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse.ir>dicate with wham
If name on record is different than that of appicant,indicate blow. Is the property in question: Anrually Assessed
❑ Real Property 0 AnnuallyAssessed
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 dry,state,and ZIP code)
4401 Theater Drive, Evansville,IN 47715
Name of assignee or ctter owner or holder of mortgage
Address of assgnee(number and street aty,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 Indana? ❑ Yes ❑ No current yea? 0 Yes 0 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
S�..i r t ur of CotnYyAuu'ditor County Date(month day,year)
I/We certify nder p' enalty of (jury t' t 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.
.. :b -(o .e .foil nam Date(month,day,year)
tacv.v
F t nt address of applicant(number and street,city,slate,and ZIP code
illi12i: 1075 E,Oakland City,IN 47660
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 610,000.