Mortgage_Seaton (2) < •
A- o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
W! FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) Gibson Ft Branch lA
e. Prescribed by Department of Local Government Finance -- - O I 1 •
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed 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 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 tuna-act buyer-see restdcbons on reverse side)
Amber R Seaton and David L Seaton II
Taxing District Key number/legal description Record number Page j)l o
Ft Branch 26-19-18-101-001.169-026 r��1 2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness un as tit Is the applicant the sole
w axssrnem date,current yea assessment date,current year date of application legal or equitable owner?
266,000.00 El 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
d Real Property 0 Arinuall5Assessed
r� 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 Dr., Evansville, IN 47715 JUN 0 3 2019
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state.and ZIP code) f�
CIBSO'N C711NTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,store amount of deduction
other county rryyet on property for
in Indiana? ❑Yes 1�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 am unt of:
20 2 2 20 20 20 20
Signature of County Auditor V Cl-fI County�� 1 Date da1�r�y
i\fvt
I/We certify under th nalty of perjury that e above and fore•• • information is true and correct and that the applicants a rebldent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ure(cvnere n ems ) r Date fmopth,ddayrJ 1
Obi P<^'LC'S` 5/c2 1/
Full resident address of applicant(number and street,city.state.and ZIP code)
804 Creek Drive, Fort Branch, IN 47648
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$10,000.