Mortgage_Emge (2) 21- 19(211-41 7i ZTA2.4 4. .4 I 4 -o2-C:3=-7--0
. 4.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION ,w
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^`•i t«� State Form 43709(Ri3!10-i5) GIBSON
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p� •
"'• '1 Prescribed by Department of Local Government Ftnanco •
INSTRUCTIONS: File Mark •
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To be flied In person or by mall. Form led 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 6'olthe immediately succeeding calendar year, County Recorder
2) Mobile/Manufactured Homes not=a'ssessod as Reel Property:Must file with the CountyAuditor.of the county
where the property is located during the twelve(12)months before March•31 of each year the deductlon is sought. •
See reverse side for additional instructions and qualifications. •
Applicant ror contract buyer- r tdctlons on reverse sld ^
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Taxin strict Key u ber/I al desert')ion Record number Pau,number •
-.,Z- .lea - ODD,Zo 9- 44 • ,:)zo . 1/ 7
A s d value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contra •ndah_(edr�s�.u, n s of is the applicant the sole .•
essment date,current year assessment date,currenl•year rrdals•of:aiiplicatlor�) legal or equitable owner? •
122,635.42 •
El Yes El No
if 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 l property in question:Annually Assessed
Real Property ❑ AnnuailvAssessed
r 1 Mobile Home(IC 6-1.1-7) •
Name moHgage.br contract seller
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Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street,illy,state,and ZIP code) Pit
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4401 Theater Drive, Evansville, IN 47715 : rr •
Name of assignee or other owner or holder of mortgage 4(jr, r ,
1
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Address of assignee(number end street,city,stale,end ZiP code) �020
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Gia• n P4 ,71 :
Does applicant own property In any If yes,what county? What Taxing District? Hee this deduction been requested./,f� s, .,; ,yfzt-of_deduclion
other county x on proPertyfor. � i. •
In Indiana? ❑Yes ❑No current year? ❑Yes 0 No Airy
A person Is not entitled to this deduction unless the person has a balance on the persons mortgage.or contract indebtedness that•ls reco/�db iiijl g county,
recorder's aide'(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: •
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20 20 , 20 20 20 20 20
Si natur=,� • Auditor County .Gate(month,day, ea
gi -''� / ; � 30 ' g. 1)' ' o z
I/We certify under lh=penalty of perjury that life above and foregoing Information is tru nd correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application Is filed,
k....4-givetar (oviper.:lull name) Dale(month,day,year)
IlrosfderiCaddross'of appl1caiiri r and-sfreel,clay,state,end ZIP code) •
."\%
10 (Iit fr.r4r,,Lt 4 i. f-,-1,,sf-JE, .3ti'g743'1
Person authorized by duly Acuted 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.
RECEIPT FOR FILING STATEMENT OF ORTGAGE OR CONTRACT INDEBTEDNESS
• Name c nl Y4 �t ortgagee or contract seller .
`�R�a`! J, /ir Il
Date filed(month,day, ea Amount of Indebtedness �' Taxi mirk
YY it
Key,}ynba 'escrip `n `eQ, O� oa.�a !f 0 2020 •
401�
Signature o o Auditor(County R rder. County O Date(mr.,lay yagr)
_j_j_e ' �f) GfaSON COU rifiz . D
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