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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
01- ,. FOR DEDUCTION FROM ASSESSED VALUATION } 2020
ie• State Form 43709(R13/10-15),r~ Prescribed by Department of Local Govrment Finance
DECEIVED File Mark
INSTRUCTIONS:
To be filled in person or by mail. TC-(, CC • MAY 2 8 2020 F rm filed with:
Filing Dates:1)Real Property:Must be completed and dated in the ca dar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or ounty Recorder of the county where the County Auditor
property is 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 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)
Brock S. Conner and Kendra S. Conner
Taxing DiNt Key number/legal description 26-19-35-400-002.693-024/4047 E.White R cord nummber z Page number
�1 jd� Oak Ln., Haubstadt, Indiana 47639 0—Of/4✓
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is legahe l applicant
the e sole
?
assessment date,current year assessment date,current year date of application quer
itable
Yes El 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: Is a property in question: Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union F ILE
Address of mortgagee or contract seller(number and street,city,state, and ZIP code) or
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)
•
CJ If yes,state amount of
Does applicant own property in any If yes,what county? What Taxing District? oHas this d o� aUVi�'OF3 deduction
other county
in Indiana? ❑ Yes ❑ No current year? ❑ 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 fine 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
Signature o -ounty• or County Date( th, a ear)
mn s g OZ°
I/We --'• •- .enalty of perjury that the above and foregoing information is true and correct and that th appli nt is a resident of Indiana and
owner/contr buyer of the aforementioned property on date application is filed.
Sig atur ner's e) �)( � ,da ,y
` (,[fix Date
ull resi address of applicant(number and street,city,state,and ZIP code)
4047 E White Oak Ln., 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.