HomeMy WebLinkAboutMortgage_Folsom (5) 5Q14 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
- ' FOR DEDUCTION FROM ASSESSED VALUATION Fk
St State Form 43709(R13/10-15) Gibson 2019
. 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. X 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)
Linda L. Folsom , William A. Folsom
Taxing Distric Tani" Key number/legal description Record number Page number
STTV1 26-19-18-304-000.430-026 20 I°1 - 616
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 I or equitable owner?
59,500.00 XI
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: e grope in question:Annually Assessed
F ❑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) SEP 11 2019
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage `7n+��,'
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUDITOR
Does applicant own p- perty in any If y what county? Wha Taxing District? Has this deduction be requested If yes,state amount of deduction
other county /f¢� _ p Taxing r� on property for � /�7y rr� r'�
in Indiana? Yes ID No -1bs�f�, I 0�-r'-�f✓�e l^� wrrent yeaR lY Yes ❑No t V. 000
A person is not entitled to this deduction unless the person has a balance Oh-the persons 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 Auditors / County Date(month,day,year)
year)
1401-N (`lk�(i„" � ' \CA
•
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 ers I I name) Date(month,day,year)
09/03/19
ident addres t ap cant(number and street,city,state,and ZIP code)
802 E Walnut, Fort Branch, IN, 47648
Person authorized by duly executed Power of Attorney 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. 42817