HomeMy WebLinkAboutMortgage_Longest ,Me s*nr, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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j l, State Form 43709(R13/10-15) q skyn`'';' Prescribed by Department of Local Government Fin ce
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INSTRUCTIONS: r 1 12-‘ 17XL( File Mark
To be filed in person or by mail Form file ith:
Filing Dates: 1) Real Property:Must be o p e nd dated in th alendar year for which e deduction is sought.
Must be filed or postmarked with the County Audito r County Recorder of the county where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 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)
Longest, Clinton R & Ashley I.
Taxing District Key number/legal description Recgr//�i umber P8e num r
Haubstadt 26-18-36-400-000.872-009 .74
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?
157,100.00 E] Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
L II' III,
If name on record is different than that of applicant,indicate below: z Is the property in question:Annually Assessed
' Ei Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit union
2 5 2021
Address of mortgagee or contract seller(number and street, i state,and ZIP code)
4401 Theater Dr., Evansville, IN Is � ;7.y
Name of assignee or other owner or holder of mortgage oUNTY ;/W ITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Yes No current year? ❑El Yes E 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
r Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature o my uditor County s_SQ"r) Date(month,day,y..
I/We certify under the penalty o - as ^ •_ • above and foregoing infor ation is and correct and that the applicant i s a2esidert lo)f IndianaN�� and•
owner/contract buyer of the aforementioned prop on ate application' filed.
Sig ,:cure(o er's full name) Date(month,day,year)
-�I„ , 7 , 01/15/2021
Full �si•ent address of appl' nuand street,ci y,state,and code)
10 West Elm St., Haubstadt,IN 4763
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)
MIL nonce iiac fnr nariron,ran inr6rrlo imnricnnmpni tin in twn and a half vearc and a fine tint in exneerl!kin non