HomeMy WebLinkAboutMortgage_Gengelbach •
err„4� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tfs FOR DEDUCTION FROM ASSESSED VALUATION
, �ng- qg
eSa\ �_Y1 State Form 43709(R14/1-20) RECEIVED E® Gibson Haubstadt 2020
• IOW Prescribed by Department of Local Government Finance -
JUN 19 2020
INSTRUCTIONS: To be filed in person or by mail. S��
File MarkForm filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. R! County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
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 �r' 0 2- CJ20 -
Haubstadt 41 (.434AC) LlJ
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applic the sole
assessment date,current year assessment date,current year date of application legal or stable owner?
$0.00 $230,500.00 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,i ate with whom
If name on record is different than that of applicant,indicate below: Is t property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller V �. ,
Evansville Teachers Federal Credit Union F I .:, ,
H
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
f
4401 Theater Drive, Evansville, IN 47715 1
Name of assignee or other owner or holder of mortgage JUN 9 2020
Address of assignee(number and reef,city,state,and ZIP code)
_____Al
_r/
Does applicant own pro pert in n Ifyes,what county? What TaxingDistrict? ,itr `.::i. .
PP P P Y 1 d If yes,state amount of deduction
other county GIBS! ,r... .r
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 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
Signature of County Auditor County D (mon�t jday ar)
m1 . Gibson (0 . t 'l • 0
I I We certify under penalty of rjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer oft e aforementio d property on date application is filed.
II
Si t e(o Hers MN Ham i to(mont ,aay,year)/009 .. , c,060,, cY vdtriraccel.L.. 6/1/2CAO
Full resident address of applicant(number nd street,city,sta e, IP 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) -