HomeMy WebLinkAboutMortgage_Coberly STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
���'.., FOR DEDUCTION FROM ASSESSED VALUATION
a-, ,I; State Form 43709(R11 6-09) RECEIVED
4Gibson Princeton 2021
" �'�, Prescribed by Department of Local Government Finance
7616
INSTRUCTIONS: CO 1 JAN 2 2 2021 File Mark
To be filed in person or by mail.
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. Form filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. X County Auditor
2.) Mobile/Manufactured Home 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)
* Jarrett Lee Coberly and Tiffany Renea Dilbeck •
Taxing District Key number!legal description �7 f^i1„ !�^l�`��o.5 _O Record number Page tuber
* * COLUMBIA VILLAGE SEC 3 17 4C5 1 o 21 l
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
* $0.00 * $0.00 *•$e:et3 1-o(0 0 6 0 Yes 0 No
If no,what is his/her exact share of interest? �Og�`� If owned with someone other than spouse,indicate with whom
°
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If name on record is different than that of applicant,indicate below: O/0 Is the property in question: Annually Assessed
Odd 1`y'� 0 Real Property 0 Annually Assessed
�oy� t' it
s\`-C Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller • '�� Iy % \\''��
* Evansville Teachers Federal Credit Union O ,45
Address of mortgagee or contract seller(number and street, city,stag and ZIP ade)
* 4405 Theater Drive,Evansville, IN 47716 el
Name of assignee or other owner or holder of mortgage 6,\;;,..
Address of assignee(number and street, city, state,and ZIP code)
Does applicant own property in any other In yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes XNo , Yes ❑ No
COUNTY AUDITOR //// \\\\
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month, day,year)
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/co tract buyer of the aforementioned roperty on date a lication is filed.
Sig,ai ,.alownery ,l;n ab Date(month, day,year)
�� • (761 I I ZOz 1
Full re• f-nt 'dress of applicant(number and street,city,sta e, and ZIP code)
* 1812 W. -ambridge Place,Princeton, IN 47670
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)