HomeMy WebLinkAboutMortgage_Hurt • , a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
44 .-•_.<;,, FOR DEDUCTION FROM ASSESSED VALUATION
7" �1 State Form 43709(R14 11.20) Gibson Patoka Township 2021 •
\•`;,„., 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 yearfor which the deduction is sought. ® 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. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) •
Wesley S Hurt
Taxing District Key number/legal description Record number Page um er i
Patoka Township 26-11-15-101-000.444-027 ,4Q,1j 34,
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?
$ 110,000 mYes ❑No
If no,what is his i 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
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union ittn
1.30
Address of mortgagee or contract seller(number and street,city,state,and ZiP code) •
c 202,
Name of assignee or other owner or holder of mortgage 1).0 Y
Address of assignee(number and street,city,state,and ZIP code) N CO�Q
Does applicant own property In any 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 1Zl No current year? ®Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the persona 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 County ' Date(month,day, ear)
\ QO a. ��c tc 'c. I a -o QQI
I/We certify under the penalty of perjury that the above and foregoin Infor Ion is true and correct and that the applicant is a resident of Indiana and
owner i contract buyer of the aforementioned property on date application is filed.
Signature(owner's/L//natnB) < ^ Date.(n/y"j onth day yea,;/� ��ff
.. . .r - I A,44 . Q^/2�ZO 21
Full resident address of applicant(number and et,city,state,and ZIP code) [[[[(
775 S White Church Road, 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 penalties for perjury can include Imprisonment up to two and a half years and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR Ila`_•- •CT INDEBTEDNESS
Name of applicant Name art ag .ntract seller
Wesley S Hurt van, i achers Federal Credit Union
Date filed(month,day,year) Amount of indebte s Taxing District
CD—Ga112,—fa( 11 , 0 1 Patoka Township
Key number I legal description •
V� �
26-11-15-101-000.444-027 cV �,.
Sign ure of County Auditor I County rder County Date(month,day,year)
(C-Q1,C5.A Q. _ 0 Gibs nai,�1 wo0o n _.A V -a 1 ,
c,004G�BS�N
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