HomeMy WebLinkAboutMortgage_Rains STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County i Township 1 Year
i FOR DEDUCTION FROM ASSESSED VALUATION
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i State Form 43709(R14.'1-20) Gibson 1 0 2 _ 1 . 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 year for 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. E 11 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on_
Taxing District Key number:legal deg/71/36bn Recoro number I Page number i
Patoka Township 26-12-16-200-001.558-027 2o2.1 I '1 3 9_5"
Assessed value of real property as of l'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?
I $65,000 FoYes E No
If no,what is his/her exact share of interest'? I If owned with someone other than spouse,indicate with whom
,If name on record is different than that of applicant,indicate below I Is the property in question,Annually Assessed
I 0 Real Property 0 Annually Assessed
I 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)
1 Name of assignee or other owner or holder of mortgage
-Z"..
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in any If yes.what county? What Taxing District? I Has this deducti n been quested If yes.state am ucticK 11
other county i on for C=> ...... .<PC
in Indiana? E Yes RI No I curpropertyrent year? as RI No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contr t indebtedness that is reco ed i he cdiPty KN,,-.1j-
Ia.)
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
I 0
COUNTY AUDITOR LIJ
Deduction approved in the amount of. )"•••••4 C=I M
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20 20 20 20 20 20
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Signature of County Auditor I County I Date(month.day,year)
Li
, GIBSON /2-2.0-ZD 2—)ll CIO n_P...-1-- C77 al /2 4 .
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:
I I e certify under the penalty of perjury that the alaWand foregoing information is true and correct and that the applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned propert on date application is filed.
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)4_, Dater•Orearrari:.dayi Year)
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Full resident address of applicant(number and street.city,state.and ZIP code)
2342 E SR 64, Princeton, IN 47670
Person authorized by duty executed Power of Attorney or by IC 6-1,1-12-0.7 I Date{month,day year)
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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 S10.000.
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RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Kenneth&LaDonna Rains Evansville Teachers Federal Credit Union
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Date filed(month,day.year) Amount of indebtedness 1 I Taxing District
$65,000 Patoka
Key number!legal des l/otion
26-12-16-200-001.558-027
i nature of County Audit
,r/Co .....Recorder County Date(month,day year)
4,1.1 WI i3 . GIBSON
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