HomeMy WebLinkAboutMortgage_Clodfelter 74 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_ ! FOR DEDUCTION FROM ASSESSED VALUATION
,._..
' State Form 43709(R13/10-15)
.� •
1 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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. 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile 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)
Clodfelter, Ericka
Taxing District Key number/legal description Record number Page number
26-19-18-304-000.141-026 40j 3 4G
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?
$52,000.00 E Yes D 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
❑✓ Real Property IN Annually Accessed
S111 obile Home(IC G1.1-7)
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)
N4401ame of asT9 assignee etr ether ownerr Drive, Evansville,ld r o smorltgl e, IN 47715 age ,UFO%tiO\9
CO
SR
Address of assignee(number and street,city,state,and ZIP code) PVO\
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been re ^if yes.state amount of deduction
other county on property for ('3
in Indiana? 0 Yes El 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 amount of:
20 20 20 20 20 20 20
Sign @tyre of County Auditor rh my Data(month,day,year)
We We certify
underthe penalty of perjury th f then IIa diforegoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of tI�e aforementioned propprty on date" application is filed.
Signature(owner's full name) t0 -rr ( _ 1r1 We
Q .}1 n Dateat(month,day,year)
VUiNVA , \ Igi,J 4}'f"/1"A_Y`�• 6//r).-Ecii 1
Full resident address of applicant(number and stree,city,st ',and ZIP code)
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,end ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.