HomeMy WebLinkAboutMortgage_Rothrock �oR,T\ne STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a \ FOR DEDUCTION FROM ASSESSED VALUATION 001 2021
Ai/ State Form 43709(R14/1-20) Gibson
tem Prescribed by Department of Local Government Finance
Patti B fi 1 e1 i i File Mark
INSTRUCTIONS: To be filed in person or by mail. S P / / Way 3/1/2021
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. m 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 buyer-see restrictions on reverse side)
Jamie S. Rothrock and William C. Atkins
Taxing District Key number/legal description Record number Page number
Barton 26-20-01-100-001.912-001 2'0 2,\ n6
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?
$40,000.00 EYes ❑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
®Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4401 Theater Drive, Evansville, IN 47715 Mar 01 2021
Name of assignee or other owner or holder of mortgage a a1
mad
GIBSON COUNTY AUDITOR CB
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 been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ®No current year? X 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
CB
Signature of Con Auditor n � County Date(month,day,year)
C,ri Gson 3/1/2021
1/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed
m Signature(owner's full nae1 Date(month,day,year)
�-✓ �� itax.f.(644,..J02/23/2021
Full r ident address of applicant(number and street,city,state,and ZIP code)
0715 E 450 S, Oakland City, IN 47660
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 CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Jamie S. Rothrock and William C. Atkins Evansville Teachers Federal Credit Union
Date filed
021ay,year) Amount of indebtedness Taxing District
$40,000.00 F I LEErton
Key number!legal description IC
,
26-20-01-100-001.912-001 Mar01 2021 �21 J C'
Signature of County Auditor/Coun Recorder CB County �p_ Date(month,day,year)
l G
%'J7sc�uuc a*ail son y d a 1/� 3/1/2021
GIBSON COUNTY AUDITOR CB