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HomeMy WebLinkAboutMortgage_Blythe (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year TwR, FOR DEDUCTION FROM ASSESSED VALUATION ��^ © � A 2021 State Form 43709(R14/1-20) 4- - Prescribed by Department of Local Government Finance J File Mark r i4 INSTRUCTIONS: To be filled in person or by mail. Fotm filed with: Filing Dates: Form must be completed and dated in the calendar year for which the deduction is sought. J\/ 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. 0 County Recorder See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Timothy W. Blythe and Cheryl J. Blythe Taxing District (Q)-1\\ Key number/legal description 26-23-18-300-000.925-024/ Rec d number Page number 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 leg o equitable owner? $328,000.00 Yes 0 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: the property in question: Annually Assessed Real Property 0 Annually Assessed FILMobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Evansville Teachers Federal Credit UnionED Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 4401 Theater Drive, Evansville, IN 47715 11/OV Name of assignee or other owner or holder of mortgage 4 202� �-� Address of assignee(number and street,city,state,and ZIP code) Gl '/ T,^~�..3 , $SON COV�.. •,e-yd. Does applicant own property in any If yes,what county? What Taxing District? Has this 111.40:y n requested If yes,state amount of other county on property f R deduction in Indiana? El Yes 0 No current year? Yes 0 No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c tr t indebtedness that is recorded in the county recorder's office(including any home equity line of credit that is recorded in the county recorder's office) at i the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Auditor Cou ty Date`(month,day,year) ,' 1 t �CC.), .` I/We certify under the penalty of perjury that the above and foregoing information is true and correct and th$ ie applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. �n rn(t,�r{ �( ���/� 1 Signature owner's full nazi) D �(7 Tit., r�.�t Full resident addre of nazi) (n er and street,city,state,and ZIP code) tt 12733 S 40 W, Hau adt, IN 639 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.