HomeMy WebLinkAboutMortgage_Bradshaw (4) "a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
?i i FOR DEDUCTION FROM ASSESSED VALUATION
�t�q�,� State Form 43709(R13/10-15)
�' - Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
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 0 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)
Eric& Jennifer Bradshaw
Taxing District Key number/legal description Re rd number Par number
Montgomery 26-11-31-400-004.824-021 01 & J6 +s
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?
$400,000 f 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 questio¢Annually Assessed
❑c Real Prope An
oir4 m e(IC 6
®aD/�i7ylobile Home(IC 6-1.1-7)
Name ofville mortgagee sellered ��
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 Pk- ILO
Address of assignee(number and street.ay.state,and ZIP code) I
((('''��.' �A�1r PV�\�\0R
014
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been reGqq. c i '1 If yes,state amount of deduction
other county on properly for q\G
in Indiana? ❑Yes LINO 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 1 20 20 20 20 20 20
Signature of County Auditor p County Date(month,day,year)
I 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(owner's ruff name) Date(month,day,year)
t_;,-lr 0'h,,, 08/09/19
Full resident address of applicant(number and street,city,state.and ZIP code)
5730 W Old Princeton Road, Owensville, IN 47665
Person authorized by duly executed Power of Attorney or by IC 9-1_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 ro two and a half years and a fine not to exceed 810,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Eric&Jennifer Bradshaw Evansville Teachers Fed Cr Un
Date fled(month,day,year) Amount of indebtedness Taxing District
8/9/19 400,000 Montgomery
Key number/legal description
26-11-31-400-004.824-021
Signature of Count'Auditor/County Recorder County Date(month,day.year)
i{,ev.in,d rrjkk5 Gibson 08/09/19