HomeMy WebLinkAboutMortgage_Folsom (4) MW'a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
•
County Township I Year
ea' FOR DEDUCTION FROM ASSESSED VALUATION I�_l?/^j `
/' State Form 46709(R13/10-16) Gibson lgenet, 2019 .
x 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. 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)
Jessica Lynn Folsom
Taxing District Key number/legal description Record number a mber
Union 26-19-18-101-001.146-026 •
ZO'a _
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicint the sole '
aswssment date,current year assessment date,current year date of application I or equitable owner?
__ - $288,800.00 — _260,000.00 _ -. _Yes 0 No - . . _
If no,what is his I 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: s e property in question:Annually Assessed
Real Property ❑Annually Assessed
` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller $ •
J �
Evansville Teachers Federal A%1
Address of mortgagee or contract seller(number and street,city,state,a IPcode)
4401 Theater Drive, Evansville, IN 47715 D SEP. 11 2019
Name of assignee or other owner or holder of mortgage •
r i
Address of assignee(number and street ity,state,and ZIP code) SEP 11 2019
GIBSON COUNTY AU;:::OR
Does applicant own property in y If yes,what county? I What T . District? Has his deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑yes No �^IBSSO�- current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has abalancc2MAigirersoi)'slfi&$age 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 County Auditor County Date(month,day,year)
ml !1� q_ kv_r`
1/We certify under the pena ty 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 perty on date application is filed.
Sig t e(owners full name) Date(month,day,year)
i �_ 09/03/19
F. resident address of a p number and st e city,state,and ZIP code)
907 Mohawk ivv ,, Fort Brach, IN, 47648
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,and ZIP code)
The penalties for perjury can include imprisonment up to Iwo and a half years and a fine not to exceed$10,000. 42809
r