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Esa STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
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7;.,._ ;; FOR DEDUCTION FROM ASSESSED VALUATION
9� 1 State Form 43709(R14/1-20) Gibson Union 2020
'' ° Prescribed by Department of Local Government Finance - - -
File Mark
INSTRUCTIONS: To be filed in person or by maiL Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. IZI 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)
Andrew R & Kelsey A Halbig _
Taxing District Key number/legal description Record number . Page number
Johnson 26-22-15-300-001.081-024 4a0ao 3q(9
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?
$ 142,000 Ir6 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 prope in question:Annually Assessed
®Real Pr y ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union
6
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) On r eo,n
Name of assignee or other owner or holder of mortgage (0,, 4 .�
4.,,
-,0A. .
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Address of assignee(number and street,city,state,and ZIP code) c i
Does applicant own property in any If yes,what county? 'What Taxing District? Has this deduction been requested If estate amount of deduction
other county on property for
in Indiana? Ill Yes ®No current year? ®Yes D No /TO
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 fine 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
Sig ture of County AuditoL -s&sL4 )
County Date month,day,year)
GibsonI/We certify under the penalty of perjury tat the abov 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.
Signafu`r (owner'seame , — , - - Date(month,day,year)
Full resident address of applicant( i nber and street,city,state, , d IP code)
12598 S Owensville Rd, Haubstadt, IN C
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDE WA SS
Name of applicant Name of mortgagee or contract s€fer '
Andrew R. & Kelsey A Halbig Evansville TeY ers al Credit Unione Federal
Date filed month,day,year) Amount of indebtedness ' T g District
I. —�S —c $ 142,000 4 Unio rQ`LS\
Key number/legal description 1.1
Evansville Teachers Federal Credit Union 00 .-a\I s-(o'
Sig I re of County Auditor/Coun Recorder County '! �, 4da yea
rill
• ; Gibson
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