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� :.*ti STATEMENT FOR DEDUCTION FROM ASSESSED VALUOF MORTGAGE OR ATION CT INDEBTEDNESS County Township Year
i',..-. '-'t'' State Form 43709(R14/1-20) 2020
.r Gibson Johnson
b`3-Ai---i Prescribed by Department of Local Government Finance
1 6
INSTRUCTIONS: To be filed in person or by melt. File Mark
Form filed with:
Filing Date: Form must be completed and dated In the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is El County Auditor
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)
Danny R.Morgan&Kathryn L.Morgan
Taxing District Key number!legal description Record number Pa�g�number c
Johnson 26=19z35;400z002.69.4a024) 4034 E White Oak Ln,Haubstadt IN 47639 4o�o / g6---
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?
$302,000.00 ®Yes ❑No '
If no,what Is his/her exact share of interest? if owned with someone other than spouse,Indicate with whom (i
N/A N/A
If name on record is different than that of applicant,Indicate below: Is the property In question:Annually Assessed
N/A ®Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7) t
Name of mortgagee or contract seller
First Federal Savings Bank
.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Davis Lant Dr.,Evansville,IN 47715 ..,8 ,
Name of assignee or other owner or holder of mortgage NO ��
N/A V r2�/�
Address of assignee(number and street,city,state,and ZIP code) UZ®
N/A
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been r&' '29.41--' •••• ,• deduction
other county on property for •in Indiana? ❑Yes ®No current year? ❑Yes ®No AUNT I-, n
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recordi:Vbounty
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. s
COUNTY AUDITOR ru
Deduction approved In the amount of:
ii
20 20 20 20 20 20 20
Signature of /AuAdit'or ..,,:a_44 County Date(month,day,year)
2
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 name) Date(month,day,year) [
11/11/2020
Full resident address of appllc nt(number and tredt,city, fate,and ode
4034 E White Oak Ln,Haubstadt I 47639
U
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) i
N/A
Address of authorized person (number and street,city,state,and ZIP code)
N/A P
The penalties for nerirrry ran Inrlurre rmnricnnmenf niltin hvn andhart unnre an 1 r,,o t 0,,e a(pen AAA r,