HomeMy WebLinkAboutMortgage_Companik (3) ��t m4�E STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 `\ FOR DEDUCTION FROM ASSESSED VALUATION
+s / State Form 43709(R13/10 15) ��� �Q�) 2020
` - . Prescribed by Department of Local Governmen ' ance RECEIVED File Mark
104
INSTRUCTIONS: pp ` MAY 2 8 2020
To be filled in person or by mail. `` J (Q.. Form filed with:
Filing Dates:1)Real Property:Must be completed and dated in t calendar year for which the deduction is sought.
Must be filed or postmarked with the County Audit or County Recorder of the county where the
property is located on or before January 5 of the immediately succeeding calendar year. 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.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kenneth R. Companik and Cynthia J. Companik
Taxing Di trict Key number/legal description
/,'(0,,I`�'
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 leg I o quitable owner?
$102,588.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with who
If name on record is different than that of applicant,indicate below: s he property in question: Annually Assessed
1.1 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _. ..
Evansville Teachers Federal Credit Union F1 , Ilk
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) "� a
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage MAY 2 8 2020
Address of assignee(number and street,city,state,and ZIP code) -�"
ORSON CONY
Does applicant own property in any If yes,what county? What Taxing District? Has this deduc ion 6eetS Y cR�"?t If yes,state amount of
other county on property for deduction
in Indiana? 0 Yes 0 No 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 20 20 20 20 20 20
1
ture o C n Au or County0 Q 1; ,_ .Dat cn y�yea C 2 g
We e u r pena t f hat the above and foregoing informa . is true ahi correct and t the applic s sident of I Tana/20
d
ig y
owner/con a uyer oft e afor entioned pro erty on date application is filed.
i ature(ow ll name) �fi /P � a n, nk_ Date onth,{lZOaO
Full resi ent'address of a licant num r and street,city,state, nd ZIP code / (/ 2
1317 W Chukar Holw., 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$10,000.