HomeMy WebLinkAboutMortgage_Ervin (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
CFOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709(R13/10-15) Gibson Patoka 2019
Piii. rescribed 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. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 0 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)
Jesse W. Ervin , Andrea M. Ervin
Taxis D fict Key number/legal description Record nu ber Pa enumber�
{�` Odl 26-12-07-403-001.492-028 2-01'-
,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of s e applicant e sole
assessment date,current year assessment date,current year date of application al or equitable owner?
66,900.00 Yes 0 No •
-- If no,;what is-his/her exact share of interest? - If owned with someone other than spouse-indicate with w m- --
If name on record is different than that of applicant,indicate below: Is he property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
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
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? ❑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
Signature of Coun udit tXl _ County Date(month,day,year)
I/We certify under the penalty of perjury a e above and foregoing information is rue and correct and that the a cant is a resident of Indi na nd
owner/contract buyer of the aforementioned property on date application is filed.
Sig Lure(owner's full name) ' Date(month,day,year)
--(Mc_ - / 108/27/19
ull resident address of applicant(number and street,city,state,and ZIP code) SEP 0 9 2019
525 S RaceStreet, Princeton, IN, 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)psayttg
Address of authorized person(number and street,city,state,and ZIP code) aIBSVN COUNTYDIT,OR
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 310,000. 42803