HomeMy WebLinkAboutMortgage_Holden (4) NEn,=e,� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshi Year
aY� � FOR DEDUCTION FROM ASSESSEn vAI �•---- p
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aim State Form 43709(R14/1•' I S �,C' Gibson Patoka Township 2020
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�"• Prescribed by Departme � /Q yqiJ °�
INSTRUCTIONS: To be filed in perso T •••...............
File Mark
Draw e 1 I\ Form filed with:
Filing Date: Form must be complet sought.
® County Auditor
1 Must be filed or postmi ,••• my where the property is
located on or before Ja Card •••••'''''''••• first due and payable. ❑ County Recorder
See reverse side for additional instructio, _-.._.
Applicant(owner or contract buyer-see restrictions on reverse side)
Mason Shane Holden
Taxing District Key number/legal description Record number Page number
Patoka Township 26-12-29-400-000.962-027 -a0Qtet 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 legal or equitable owner?
$107,920.00 IZYes ❑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 e property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Jr
Evansville Teachers Federal Credit Union - I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
46.1 1,
Name of assignee or other owner or holder of mortgage Ot� r�
Address of assignee(number and street,city,state,and ZIP code) G'/es G �0��/
oN
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Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been req te`amount of deduction
other county on property for
in Indiana? ❑Yes ❑No current year? ❑Yes ❑No 41.
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that II orded 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 deduc ion.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sig t re of County Auditor c/fIrtx_
County Date(month,day,year)
ti Gibson 10/21/2020
I/We certify under the penalty of perjury that the ab ve an regoing 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.
ignature nets f I name Date(month,day,year)
1012 117°0-0
11\-F re ident ddress of app. a (number and treet,city,state,and ZIP code)
17 S 125 E, Princeton, IN 47670 .
erson 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 ceriuni can include imprisonment up to two and a half years and a fine not to exceed$10,000.