HomeMy WebLinkAboutMortgage_Dutkiewicz (2) of.T4r. STATEMENT OF MORTGAGE OR CONTRACT INDERTEDNESS County Township Year
y,...;.-�' 4 FOR DEDUCTION F (
a:tt;.,.,, State Form 43709(R13/10-15) V v U 7 Gibson JOhnson Township 2020
'i` ^"%J' Prescribed by Department of Drawer
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INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be cot Card N O. ion is sought.
Must be filed or postmarke, where the property is III County Auditor
located on or before Janua ' ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 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)
Timothy E &Amy B Dutkiewicz
Taxing District Key number/legal description Record number Page number
Johnson Township 26-23-07-100-002.430-024 2020 c Li 7
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 legal or equitable owner?
$205,000 ❑■ Yes ❑ 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 the property in question:Annually Assessed
■❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Evansville Federal Credit Union
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Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage \G��
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Address of assignee(number and street,city,state,and ZIP code) " O
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Does applicant own property in any If yes,what county? What Taxing District? Has thi ' duc`tibn been requested If yes,state amount of deduction
other county ant
for
in Indiana? Ill Yes ❑� No -hint year? ❑I♦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 Date(month,day,year)
:. -/ Gibson 8/11/2020
I/We certify under the 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.
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Signature nets full name Date(month,day,year)
Gam= 08/11/2020
Full re 'dent acts, of applican and st et city,state,and ZIP code)
5 W 1100 S, Haubst df, IN 4763
Person authorized by duly exe�ted-PeweAttorney 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.