Mortgage_Neufelder (6) ..•^�� ,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_I_-_ FOR DEDUCTION FROM ASSESSED VALUATION non
5 LI State Form 43709(R13/10-15) Gibson Ft.Branch
°� Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. sled 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 contract buyer-see restrictions on reverse side)
Darwin G. Neufelder
Taxing District Key number/legal description R rd number Pa e n r
Ft Bran -18-303-000.196-026Q�
Assessed value �as of ortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpai as of Is the applicant the sole
••ccrnent dat e�J w<smem date,current year date of application legal or equitable owner?
97,500.00 p Yes 0 No
If no,what is his I her a tthte g inn? If owned with someone other than spouse.indicate with whom
If name on record is differem than thatLoff applicant below: Is the property in question:Annually Assessed
•BituA : c p Real Property ❑ Mob Annually
s(IC 1.1-7)
Name of mo6113910♦•ttrerr3d'seller i.r:-"Lir i vR
Evansville Teachers Federal Credit Union
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.aty,state.and ZIP code)
Does applicant own property in any If yes,what county? 'Mort Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the persons 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
Signature o my Audit/3 '\ Countyj1 Date
1 lyl`
I/We ce under the penalty of perjury tha e above and foregoing information is tru a d correct and that the applicant is es dent of Indiana and
owner/ act buyer of the aforeme tioned property on date application is filed.
Si at (owne full homier) ge, Date(
Full redent address of applicant(number and stre .city state,and ZIP code)
107 S. Willard Street, 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 310,000.