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,A ^Fie, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
° r ' Gibson Ft. Branch 2020... State Form 43709(R1411.20)
t' ; �^ 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. ® 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.
l Applicant(owner or contract buyer-see restrictions on reverse side)
Brian& Robin Resenbeck
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-19-19-102-000.357-026 2020 . 2792
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?
$116,000 lJYes ❑No
4 If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom '
I
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
®Real Property ❑Annually Assessed
-E?-4.41
1 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '
a
Evansville Teachers Federal Credit Union AFC, ,
411,
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ,�
i Name of assignee or other owner or holder of mortgage /eS �O�O
-v)r•44124,-.1 ,
Address of assignee(number and street city,state,and ZIP code) 7.), IAA
Does applicant own property in any If yes,what county? What Taxing District? iiililies this deduction been requested If yes,state amount of deduction
other county °petty for
in Indiana? Eves ®NO current year? ®Yes ❑No
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:
i
1
20 20 20 20 20 20 20
Sig ture of County Auditor County Date(month,day,year) '
Gibson
1/We certify under the pens ty of perjury that the above f 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.
Si. e(owner' fur me) Date(month,day,year)
/Z./I 4!=s/2 o o
Full resident ad ass of applicant(number and street,city,stale,and ZIP code)
607 E Oak St., Ft. Branch, IN 47648
i 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,slate,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 INDEBTEDNESS
Name of applicant Name of mortgagee or cunt:G
Brian& Robin Resenbeck Evansville T-: e F deral.Credit Union
I Dat filed(month.day,year) Amount of indebtedness .T mg District {
_1 l — c . �� $ 116,00 Ft. Branch
Kay number/legal description O�%
26-19-19-102-000.357-0 6 �- Y
Sig ure of County Auditor I County R c rder County C C `1 Date(myth,day,year)
Gibson 0 � �, I I- ,� -
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