HomeMy WebLinkAboutMortgage_Earnst (2) S :7.,—g; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
`•a FOR DEDUCTION FROM ASSESSED VALUATION
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�� ) .:„E�D State Form 43709(R13/10-15)
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�,y Prescribed by Department of Local Government Finance
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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)
Christopher D. Earnst and Jamie L. Earnst
Taxin D'strict Ke nu ber/legal description Record number Pa a number
1p —1$—0 —10 0 -000. (J'o-mil . 2?0 ZO 1Z
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract ind6ebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
/ pt00. ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than speGse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
i .IN peal Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street,city,slate.and ZIP code) J AN 10 2020
4401 Theater Dr., Evansville, IN 47715
Name of assignee or other owner or holder of mortgage alefit.c0a-------
'
Address i 24'i,
GIBSON GuuNTY AUDITOR
0
NO a ,-axing District? Has this deduction been requested If yes,state amount of deduction
Does
. Drawer g property q
onfor
in Indiar current year? ❑Yes ❑No
A persoi 1 a� dance on the person's mortgage or contract indebtedness that is recorded in the county
recorder Card NO. rded 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 it r County Date(To h,day,y ar)^o
&:.) - 1 t .
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant i a resid t of Indiana and
owner/contract b yer of the aforementioned property on date application is filed.
Signature(owner's full n e) Date(month,day,year)
.D mbe r( h&� 01/03/2020
Full resident address of applicant(nu and street,city,state,and ZIP code)
6292 W Old Princeton Rd., Owensville, IN 47665
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 nenalties for oeriury can include imprisonment up to two and a half years and a fine not to exceed$10,000.