HomeMy WebLinkAboutMortgage_DeHaven (2) „,fq, STATEMENT OF MORTGAGE OR CONTRACT INDEBT:11 u! Township Year
i r>a. FOR DEDUCTION FROM ASSESSED VALUATION i .
.., ' -;,r s 2020
I° -i t State Form 43709(R13/10-15)
't ',; Prescribed by Department of Local Government Finance JAN 10 2020 File Mark
iiiTiC
INSTRUCTIONS:
To be filled 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 ded c
Must be filed or postmarked with the County Auditor or County Recorder of �}i jr6 �Y AUDITOR ❑
property is located on or before January 5 of the immediately succeeding c r ar. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ❑ County Recorder
county where the property is located during the twelve(12)months before March 31 of each year the _ _ __
deduction is sought.
-:,averse side for additional instructions and qualifications.
^:Pcant(owner or contract buyer-see restrictions on reverse side)
_. c!!W. DeHaven
2::icci District Key number/legal description 26-11-15-101-003.715-027/2624 W Jill Dr. Recoi ri Pagetr) ber_
Princeton, Indiana 47670 (:71 CJ (/
essed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
.. :,sessment date,current year assessment date,current year date of application legal or equitable owner?
$169,686.00 ❑Yes ❑ No
it 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
0 Real Property 0 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,state,and ZIP code)
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
I Address of assignee(number and street,city,state, and ZIP code)
applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of
county on property for deduction
,uuana? 0 Yes 0 No ,current year? ❑ Yes 0 No
,:':son 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
-.'rr'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.
L COUNTY AUDITOR
I. .it c FAA approved in the amount of: •
20 20 20 20 20 20 20
• ignature of County Auditor County Date(month,day,year)
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.
gn owners ful e Date(mOntl7,day,year),
Full resident address of applicant(number and street,city,state,and ZIP code)
2624 W Jill Dr., Princeton, IN 47670
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)
T e penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.