HomeMy WebLinkAboutMortgage_Gengelbach (2) 'igf rar. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fIk. '" . FOR DEDUCTION FROM ASSESSED VALUATION
` " Gibson Haubstadt 2019
c' ,) Sat Fo na 43709(R13110-15)
HF 4 Prescribed byDepartment 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 Q 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 0 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)
Kevin L. Gengelbach and Jennafer L. Gengelbach
Taxing District Key number/legal description Record number Page number
26-19-31-400-000.764-009/BRIARWOOD SUB DIV II LOT _
41 (.434AC) 2-CAR 4140 2
Haubstadt
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 legal or equitable owner?
$0.00 $227,000.00 ❑x Yes ❑ 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 the property in question:Annually Assessed
l Real Property 0 Annually Assessed
-mayMobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �e?
Evansville Teachers Federal Credit Union / Yi ! . +
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4401 Theater Drive, Evansville, IN 47715 NOV 0 4 2019
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) gyp)
li rt vtn property fn a, If yes,what county? What Taxing District? q 1 Tl:9V_trcYo45 W Teg sted If yes,state amount of deduction
uII7:- :, -,Yes L�IyJ'/Nu on pr'o f ry for� rra.
c�tr.Brit year?. ❑Yes ❑No'
^,person is not entitled to this deduction unless the person has a ba/a:?c.e on the personis mortgage or contract indebtedness that is recorded In the county
recorder's of ice(inciuding any home equsy line of credit that is recorded in the c0(llify recorders 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 S &N111-iln _____) County Dqt�(rpont i y,year) •
Gibson I`•1 q
I I We certify under 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.
'Sig ture'(own`�er name) Date(mo-th`;�dayj eat)
vy\
F I resident a ress of applicant(number a street,city,state,and ZIP code)
704 E Laurel Ridge Ct., Haubstadt, IN 47639
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 St ..000_