HomeMy WebLinkAboutMortgage_Campbell (9) .o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i FOR DEDUCTION FROM ASSESSED VALUATION
I State Form 43709(R13/10-15) Gibson P,toka 2019
,a Prescribed by Department of Local Government Finance t u�S f
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)
Jennifer Lynn Campbell ,
Taxing District \ ie Key number
-4leg0l -003.5 Record" ury¢er Pag�numgpi�
Patoka vJ N 26-12-05�00-003.523-027 , I`U� `nIS (l�1>`
Assessed value of real property as Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app scant the sole
acceccment date,current year assessment date,current year date of application al or equitable owner?
$159,100.00 145,000.00 Yes 0 No
• - -If ne,what is his/her exact share of interest? If owned with someone other than spouse:indicate with w om — -- -- - --- -- '
If name on record is different than that of applicant,indicate below Is e property in question:Annually Assessed
Td Real Property 0 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) " rLJ
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
SEP 11 2019
Address of assignee(number and street,city,state,and ZIP code)
flrwc applicant own property in any It yes,what county? What Taxing District? on been requested If yes,state amount of deduction -
other county GIBSON-MOM fAUmOR
in Indiana? ❑Yes El 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 County Auditor C,\�(�\J�J� D. County Date nfh,jea,)y
I/We certify under the penalty of perj�thatteabove and foregoing information is true and correct and that the applicant�s a�ri�nt of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ure(owaer's full name)ilit
Date(month,day,year)
vry��^��((( 08/28/19
Full ident ad of appli t(number and streetycrty,stnd ZIP code) •
A:6 E T own Road, Princeton, IN, 47670
Person authorized by duty 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 two and a half years and a fine not to exceed$10,000. 42753 .