HomeMy WebLinkAboutMortgage_Farmer (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS .r» Township Year
_n, = FOR DEDUCTION FROM ASSESSED VALUATION �t
al State Form 43709(R13/10-15) 1
'' ,I Prescribed by Department of Local Government Finance Y '
INSTRUCTIONS: r c , 10 File Mark
To be tiled in person or by malt C7 V Form file with:
Filing Oates: 1) Real Property Must be completed and dated in the calendar year for which the decgon is sought
Must be filed or postmarked with the County Auditor or County Recorder of the county where th p • County Auditor
located on or before January 5 of the immediately succeeding calendar year. pR 0 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must rile with the Co fit$
where the property is located during the twelve(12)months before March 31 of each ra is sought.
See reverse side for additional instructions and qualifications. MSS
Applicant(owner or contract buyer-see restriction on reverse side)
Farmer, Riley B.
Taxing District Key number/legal desolation • Rep umb= Page number
Haubstadt 26-18-36-402-000.363-009 / cild
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 appbcation legal or equitable owner/
$116,000.00 p Yes ❑ No
If no,what Is his I her exact share of interest? If owned with someone other than spouse.indicate with whom
If came on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
i) Real Property ❑ AnnMo uaile Home Q 61.1-7)
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)
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Dees applicant own properly in any If yes,what county? what Taxing District? Has on property
deduction been requested If yes,state amount of deduction
other ONo current year? ❑Yes ❑No
InIndiaia Indiana?
❑Yes
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_
Sig 7�}��of County Audiitor r 'k County Date(month,day,year)
/We certify under the penalty of perjury that th above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application Is filed.
Signature(owner's me) Date(month,day,year)
3. 03/)a/yaoj I
Fug resident addre applicant(number and street,city,state,and ZIP code)
403 West Church Street, Haubstadt, IN 47639
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S 10,000.