HomeMy WebLinkAboutMortgage_Sisk Jr (2) Oar I, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ���1 my Township Year
cl .• •(a FOR DEDUCTION FROM ASSESSED VALUATION
1- «� L-- � State Form 43709(R14/1-20)
2021
Prescribed by Department of Local Government Finance tie(N�rk
INSTRUCTIONS:
To be filled in person or by mail. Form filed 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
property is located on or before January 5 of the calendar year in which the property taxes ae first due County Auditor
and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Vernon Lee Sisk,Jr. 31
Taxing D• r Key number/legal description /6183 W.Stalheim Ave., Owensville, Rez�ord nymber Page number
oi►71 Indiana 47665 24- //j-3np , 004/ aya- 0e2.l O/ 1"(0�3
Assessed v uepf al grope as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment dat&-current year assessment date,current year date of application legal or eq�tuitable owner?
$241,300.00 t.0Yes ❑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 property in question: Annually Assessed
al Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) s
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
tit
Address of assignee(number and street,city,state,and ZIP code)
0 �0
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction be requested If yes,sir e Yv oik
other county on property for dedu ti ,' NO
in Indiana? ID Yes 0 No current year? a es 0 ,(01
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contr ct indebtedness t orded 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 eduction.
'COUNTY AUDITOR ----
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sig a ure..of County Auditor I����)� . Coun Date(month,day,year)
/VU�f11e dUGI./'k//1S, �56.J 2- t/- Z02•—/
I/We certifyunder the penaltyof perjury the a overe foregoing information is true and correct and that the applicant is a resident of Indiana
A P 1 Y9 9 PP
and o ner/contract buyer of the aforem coned property on date application is filed.
$igpat r (okwns f na e) Da11i1'z-(
(front ,year)
Full r sident address f pplicant(number and street,city,state,and ZIP code)
6183 W Stalheim Ave:, Owensville, IN 47665
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.