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HomeMy WebLinkAboutMortgage_Davids 6�4rF STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION . �e ( 2020 ., )q State Form 43709(R13/10-15) "\ \ r,'r' Prescribed by Department of Local Government Finance File Mark ioi® INSTRUCTIONS: To be filled in person or by mail. Form led with: Filing Dates: 1)Real Property: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 County Auditor 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 0 County Recorder 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) Greg Davids Taxing District ociC1 Key number/legal description 26-19-31-304-000.321-009/504 E. Gibson Record number Page number St., Haubstadt, Indiana 47639 t)`/q Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is thhe r equitable the e er?sole assessment date,current year assessment date,current year date of application $117,100.00 Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with who If name on record is different than that of applicant,indicate below: Is he property in question: Annually Assessed A Real Property 0 Annually Assessed _ Mobile Home (IC 6-1.1-7) Name of mortgagee or contract seller Evansville Teachers Federal Credit Union y ED Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 4401 Theater Drive, Evansville, IN 47715 NOV 3 Name of assignee or other owner or holder of mortgage 1020 Address of assignee(number and street,city,state,and ZIP code) O'fgSO N Cp/, Does applicant own property in any If yes,what county? What Taxing District? on property deduuc'on b en requ�Has csttj0f..,O d yes, i statea amount of other county in Indiana? 0 Yes 0 No current year? 0 Yes 0 No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or cont ct 1 ebtedness 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)tha is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Sig re of County Auditor Count Date(month,day,year) t I I - a. _.c -gp, 1-o I/We certify under penalty of perjury that bove and foregoing information is true and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementione property on date application is filed. Date(month,day,year) Sign ture(owner' 11 m /© __3 0 —,z c:'' Fu sident addres f applicant(number and street,city,state,and ZIP code) 504 E Gibson St., Haubstadt, IN 47639 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.