HomeMy WebLinkAboutMortgage_Novotny (3) G°i--n_ 4 FSTATEMENT()TART
R DEDUCTION•
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State Form 43709(R 13/10-15) —
Prescribed by Department of Local Government Finance j ED
INSTRUCTIONS: 1 File Mark
To be filed in person or by mail. JUN 8 2019 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 filed or postmarked with the County Auditor or County Recorder of the county wh 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 tiAgpg my
where the property is located during the twelve(12)months before March 31 of el.619 GQ oY5 i&ktt IRO R
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Joseph Patrick & Cassandra Lee Novotny
Taxing District Key number/legal description Rird n r Page number
White River Township 26-05-58-026-000.854-018 O� 2406
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,current year assessment date,current year date of application legal or equitable owner?
$91,000 0 Yes ❑ 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 the property in question:Annually Assessed
0 Real Property ❑ Annually Assessed
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.city,state,and ZIP code)
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 any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? LE 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 amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
Jam'_ •'z Gibson 06/18/19
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 buyer of the aforementioned property on date application is filed.
Signature(owners full name) Date(month,day,year)
POk fix 06/18/19
Full resident address of applicant(number and street,city,state,and ZIP code)
5440 N 75 E, Patoka, IN 47666
Person authorized by duly executed Power of Attomey 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 510,000.
FILED-
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Joseph Patrick & Cassandra Lee Novotny Evansville Teachers Federal Credit dial 8 2019
Date fled(month,day,year) Amount of indebtedness Taxing District
06/18/19 $91,000 White River Tow hip
Key number/legal description
26-05-58-026-000.854-018 GIBSON COUNTY AUDITOR
Signature of County Auditor I County Recorder County Date(month,day,year)
amnt ,<y Gibson 06/18/19