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°R"► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS S County Township Year FOR DEDUCTION FROM ASSESSED VALUATION
'`,V. State Form 43709(R14/1-20) Gibson Montgomery 2021
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4, Prescribed by Department of Local Government Finance RECE.
� � / ��21 File Mark
INSTRUCTIONS: ►�O� j JAN 2 8 Form filed with:
To be filed in person or by mail.
Filing Dates:1)Real Property:Must be corn.-'-d and dated in the calendar year for which the deduction is sought. X County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the 0 County Recorder
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
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) '
Devin S.Deisher, Katie A. Deisher
Taxing District Key number!legal description Record number Pa e nurpber
Montgomery 26-11-31-300-004.243-021 �`2,1 (y4
Assessed value of real property as of I Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app scant the sole
assessment date,current year assessment date,current year date of application le al or equitable owner?
$222,500.00 : •, i Yes ❑ No
If no,what is his/her exact share of interest? If owned w' II: an •o indicate with whom —
If name on record is different than that of applicant;indicate below: Is e property in question:Annually Assessed -
Real Property ❑Annually Assessed -%%'i k Mobile Home(IC 6-1.1-7)
Ar 1
Name of mortgagee or contract seller " •
Evansville Teachers Federal nn e/�r
oft
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) tif/ '�°PVU
4401 Theater Drive, Evansville, IN 47715 �0
Name of assignee or other owner or holder of mortgage •
G,BSON
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction b en requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes 7No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or on act 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)tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 IN
20 20 20 20 20Signature of C r}tsr t4u itprCou 3 Date(l' d yea `
a.
•
I/We certify underW the penalty of perj th he above and foregoing informatio ' true and correct and that the applicant is aarresident of Indian9 and
owner/contract buyer of the aforementioned property on date application is filed.
Sig attire owners full na Date(month,day,year)
S' 14.„___An. A. 01/12/21
Full resident address of applicant(number and street,city,state,and ZIP c de
PP )
6195 W Stalheim Ave, Owensville, IN, 47665-9104
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. 46236