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t,,s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Do- ww, �."
;'in> FOR DEDUCTION FROM ASSESSED VALUATION
Gibson 0Z2 2020
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�� 4, State Form 43709(R14/1-20) •
RECEIVED
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. cO,.S.SC 1 OCT 0 1 2020 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. . - K 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)
Alexander Brian Barnett and Sara Salome Barnett
Taxing District Key number/legal description Record number Page number
Owensville 26-18-07-101-000.055-022/PT NW 7-3-11 .64 AC -2'OZO ' 24 _
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli nt the sole
-assessment date,current year assessment date,current year date of application legal or a itable owner?
$0.00 $189,053.00 es ❑ No
If no,what is his I 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 tRe property Yin question:Annually Assessed
0 Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
F I Name of mortgagee or contract seller ,f s
Evansville Teachers Federal Credit Union Address of mortgagee or contract seller(number and street,city,state,and ZIP code) OCT 01 2020
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage ty'
Address of assignee(number an street,city,state,and ZIP code) 'Ai"^"
GIBSON COUNTY 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 ❑Yes No' on property for El Yes 0 No
in Indiana? current year?
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)
>ml I 11 Gibson • I O 1.2a 20 •
I/We certify under penalty of perjury that th a 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 namee ' • Date(month, ay year)
ca ' 04.34 Pi .1.a..4---A
Full.reside address of applicant(number and street,city,state,and ZIP code)
mil ��Z��� ��316 Delaware St., Evansville, IN 47711 •
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)
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