HomeMy WebLinkAboutMortgage_Grigsby (3) "'"''P STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- t FOR DEDUCTION FROM ASSESSED VALUATION
aSiate Form 43709(R13/10.15)
Gibson 2019
Ste, JJ Prescribed by Department of Local Government Finance ��
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. X County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the ❑ County Recorder
property is located on or before January 5 of the immediately succeeding calendar year.
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)
Jared D. Gri sb
Taxing District 0I \1c Key number/legal description Record nytuber Pageube,
MoMtgemefy 26-17-12-202-000.017-022 Zdl U. m
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,anent year assessment date,current year date of application legal or equitable owner?
$85,000.00 121,125.00 0 Yes ❑ No
If no;what is his/her exact share of interest? If owned with someone other than spouse,-indicate with whom —
If name on record is different Nan that of applicant,indicate below: Is the property in question:Annually Asvecced
0 Real Property 0 Annually Assessed
Mobile Home(IC 6-7.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
4401 Theater Drive, Evansville, IN 47715 JUL .$ 2 zais
Name of assignee or other owner or holder of mortgage
•
n j
Address of assignee(number and street,city,state,and ZIP code)
tt4;fu.
GIBSON COUNTY A.;=ITOR
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? El Yes ❑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
Signature of Count:
ount Cr 1, czta County Date(month.lay y arl
I I We certify he penalty o try that the above and foregoing information is and correct and that the applicant is a.esid t of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Sign ure(owner's full n Date(month,day,year)
ls�s� _ / 07H5H9
Ful vdent address of applica ( tuber and street,city,state,and ZIP code)
03 N Third Street, Owensville, IN, 47665
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 S10,000.