HomeMy WebLinkAboutMortgage_Davis (2) 3" e,rp4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS' 1,0ktit.,, County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13 110-15)
* * Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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 ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
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)
DYLAN LEE DAVIS
Taxing District Key number/legal description Record_number Page number
Columbia Township 26-13-22-400-000.298-006 PI— 'c2 9 N
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applica the sole
assessment date,current year assessment date,current year date of application legal or • ble 9 per?
$113,500.00 Yes LJ 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 th property in question:Annually Assessed
Real Prope Annually Assessed
Mobile Home IC 6-1.1-7
Name of mortgagee or contract seller
Heritage Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4920 Vogel Road, Evansville, IN 47715 OCT 21 2019
Name of assignee or other owner or holder of mortgage
,404:estjuet-----
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUDITOR
Does applicant own property in a 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?El ❑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 ,I' ,A 20 20 20 20 2
Signature of County Auditor County Date(month,da ,year
I/We certify under the •11 alty of perjury that the above and foregoing information is true and correct and that the applicanPis`�r sident f I dian and
owner/contract buyer of the aforementioned property on date application is filed.
ig aturer(Qwner's full name Date(month,day,year)
�p��/} ?�� 08/15/19
Fu I resider address of applicant(number and street,city.state,and ZIP code)
2229 South 950 East, 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.