HomeMy WebLinkAboutMortgage_Riley (12) 4 .. STATEMENT OF MORTGAGE OR.CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION Gibson } 2019
% '; State-Fomr 43709(R13l 10-15)
Prescribed by DeOartment of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is 171.County Auditor
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 ❑ County Recorder
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)
Kendra Riley
Taxing District Key number/legal description Record number Page num12 er
444=1 H \rani ,, 26-18-13-404-000.184-026/OLD PLAN 15 PT 2Zo l-1 . 36 7-1
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant t sole
assessment date,current year assessment date,current year date of application legal or equit a owner?
$37,100.00 $52,000.00 es 0 No
If no,what is his/her exact share of interest? If owned with someone other than spou -,indicate with whom
If name on record is different than that of applicant,indicate below: Is the r,•perry in question:Annually Assessed
17 -e I Pr o ■ nnually Assessed
Name of mortgagee or contract seller ._ a
r obile Home(IC 6-1.1-7)
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) L��9
4401 Theater Drive, Evansville, IN 47715 OCT 1
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ci state,and ZIP code)
GIBSON COUNTY AUDITOR
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. o current year-? ❑les ❑No
A person is not entitled to this deduction unless the person has a balance on the persons mortgage or contract indebtedness that is recorded In the county
recorder's office(including any Koine 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
Signature of County Auditor ID County Date nth, year)
.ty111 Gibson t (( `q
I/We certify under pena o perjury that the a ove and foregoing information is true and correct and that the applicant is a re den of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
gnat^ -owner's II name) --Date-(mon 4 day,year)-
Full resident address of applicant(n ber and street,city,state,and ZIP code)
200 E.Walnut St, Fort Br nch, 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 pe:jurycan include imprisonment°irp to two and a half years and a fine notto.exceed$10,000-