HomeMy WebLinkAboutMortgage_Hutchinson (4) ,eR� ,, STATEMENT OF MORTGAGE.OR CONTRACT INDEBTEDNESS County Township Year
"%_`*�,� FOR DEDUCTION FROM ASSESSED VALUATION
5-:J..-, 11. State Form 43709(R14/1-20) Gibson Patoka Township 2021
'°:,eie;i Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. E County Auditor
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 are first due•and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications. •
Applicant(owner or contract
Taxing District Key number/legal description Record number Page number
Patoka Township 26-12-15-200-002.312-027 dQa/ Jloef
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?
$124,000 2Yes ❑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-- - -
E Real Property ❑Annually Assessed
Moe(IC 6 1.1 7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union .s
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
lill'jA:"Li('-‘ 7...
Name of assignee or other owner or holder of mortgage f1 ®`�
FED ! , )
Address of assignee(number and street,city,state,and ZIP code) • i c J;;..;,t,•a"
,00-(O R
�L ;,0:1Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested 0 ttatttat�amount of deduction
other county on property for
in Indiana? ❑Yes E No current year? ❑Yes .❑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 County Auditor 1 `�,� I County Date(month,day,year)
JAL01-CULL CA.. /Vt - Si ( Gibson 2-17-202,1
I/We certify under the penalty of perjury that the above ap foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on a application is filed. _
S elute ow es u/ a e) i� C<i/eii"✓ :,•-• 7.< _-••••• ,,,..,c;;:"..-., fe — e)2,/
Full resident address of applicant(number and street,city,state,and ZIP code)
947 S Dogwood Ln, 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)
The enalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. . a�