HomeMy WebLinkAboutMortgage_Campbell (5) - STATEMENT OF MORTGAGE OR CONTRACT INDE E--DNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
'j +tr, State Form 43709(R13/10-15) Gibson Ft.Branch 2020
% ,eiee Prescribed by Department of Local Government Finance RECEIVED
'�J _ , File Mark
INSTRUCTIONS: 1-Z I SEP 1 8 2019 Form filed with:
To be filed in person or by mail.
Filing Dates:1)Real Property:Must be complet d and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the ❑ County Recorder
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 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)
Zackery Tyler Campbell , Catrina Lynn Campbell
Taxing District Key number/legal description Record nu�� Pgge nurppeF
Ft. Branch 26-18-24-204-000.807-026 -0 lr(']1'vy 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 le I or equitable owner?
$205,200.00 165,600.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with om
if name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed •
Real Property 0 Annually Assessed
ile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r r
First Federal Savings Bank 1._ z '
a
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Davis Lant Drive, P.O. Box 1111, Evansville, IN 47706-1111 SEP ,12320
Name of assignee or other owner or holder of mortgage .
•
Address of assignee(number and street,city,state,and ZIP code)
GIBBON C AUDITOR
Does applicant own property i any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? ❑Yes ❑No
A person is not entitled t 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(includi g 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)
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.
Signature owner's full me) Date(month,day,year)
CI 4 'et,
� G � 08�28�20
resident a ess of scant numbe city,state,and Z code)801 S Main Street, Fort zh, IN, 47648
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. 45627