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HomeMy WebLinkAboutMortgage_DAisey ;,„64.* ; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 0/' "s la FOR DEDUCTION FROM ASSESSED VALUATION .1 © �C a 2 � S � Y/3'' . > State Form 43709(R14/1 20) :,- File Mark ...t__,:� Prescribed by Department of Local Government Finance rage INSTRUCTIONS: To be filled in person or by mail. F rm 'led with: Filing Dates: 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 County Auditor property is located on or before January 5 of the calendar year in which the property taxes ae first due and payable. ❑ County Recorder • See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) George K. Daisey III and Melanie Daisey Taxing District Key number/legal description /10629 S 525 E, Haubstadt, Indiana 47639 Record number Page number QZk1 . —z3—pi-Zoo- ooloi3 R-oz g_O?\ 1I(A3 Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of ortgage/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? $354,000.00 ❑Yes 0 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 roperty in question: Annually Assessed Property ❑Annually Assessed F 71 1: .1_IL,..:— ., Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Evansville Teachers Federal Credit Union � tZ� Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 6v" 4 - 4401 Theater Drive, Evansville, IN 47715 Name of assignee or other owner or holder of mortgage fi, Aeff444141 Address of assignee(number and street,city,state,and ZIP code) �G18Sr 0 Y "I) Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes, state amount of other county on property for 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 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: 20 20 20 20 20 20 20 Signature of Co ty u ito County \ ^ _ Date(T h d y,y ..._2_, c.) ..A-10 I/We certify under the penalty of perjury that the above and forego g information is true and correct and th the app'cant is a resident of Indiana and owner/contract buyer of th orementioned property on da plication is filed. Signa re wner's full name) Date(rf ontt7.,day,year) Full resident address of ap cant(number and street,city,st e,and-21P code) 10629 S 525 E, 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.