HomeMy WebLinkAboutMortgage_Shoultz (2) 441—N, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
„40-4:-:21:,1. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15) Gibson Columbia 2019 •
e' Prescribed by Department of Local Government Finance
iem
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)
Samantha E. Shoultz , Gregory A. Hays
Taxing District Key number/legal description Record number Paae
\nother
z0
Columbia 26-13-27-100-000.475-006
indebtedness unpaid as of Is th pplicant the sole
assessment date,current year assessment date,current year date of application le or equitable owner?
$101,000.00 301,150.00 Yes 0 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 a property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED
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 OC I 01 2019
Address of assignee(number and street,city,state,and ZIP code)
RR n(� �r(� -rpp {��
Does applicant own property in y If yes,what county? What Taxing District? Has thh18Su�tion been rA0este'dU ITe,'slate amount of deduction _
other county r,( on property for
in Indiana? ❑Yes LYJ 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 . County Datg(month,day,year)
. i . ,,
I/We certify under the pena y o perjury that the 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.
Si ature(ownes full name) _ Date(month,day,year)
,14 .1(,A, •C - :/Z __�._� 09/27/19
Full resident address of applicant(number and stf�et,city,state,and ZIP code) 4{
2750 S 850 E, Oakland City, IN, 47660 '
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. 42956