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HomeMy WebLinkAboutMortgage_Meny (13) , ., . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year `' ' 5.:' FOR DEDUCTI( - - "^• cicln VALUATION State Form 43709(R14/ Gibson Johnson 2021 `- Prescribed by Departs File Mark INSTRUCTIONS: To be filed in pa D ra«'C't NO •• Fort filed with: • Filing Date: Form must be corn, sought. © County Auditor Must be filed or pc Card NO. .1. ... inty where the property is El County Recorder located on or befa ., a first due and payable. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Margaret Meny Taxing District Key number/legal description Record number Pa a number Johnson 26-23-14-400-001.752-024 Oc., „ 1 `7 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 cc) legal or equitable owner? $Ky2 1 OLI 10Yes ❑No If no,what is his/her exact share of interest? If owned witssh??someon\\e other than spouse,indicate with whom If name on record is different than that of applicant,indicate below: Is the prop in/rgqu�uestion:Annually Assessed 0 Rea��C Assessed MobileAnnua Home(IC 6-1.1-7) Name of mortgagee or contract seller -•(/� Evansville Teachers Fed CU � q �`` Address of mortgagee or contract seller(number and street,city,state,and ZIP code) [,C`'G -, )4 Name of assignee or other owner or holder of mortgage Ci'y�SON cOG J CO& Address of assignee(number and street,city,state,and ZIP code) N .7 >>� Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yesnstatOkmount of deduction other couna?ty ❑Yes No ocurpentyear?r Yes El No in I 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 County Date(month,day,year) ,ram -�(\..k Sir..n Q - •...� - -4.---;-qIC) Gibson am• "'c0 ( —..O Ja-J I/We certify under the penalty of perjury that the above and foreg inrmation 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. Signature(o�yi/yr's full name) Date(month,day,year) If z fV 12/21/2021 tci dn residt address of appli t(number an street,city,slat ,and ZIP code) 4095 E 1300 S, Evansille, IN 47725 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 imnn,,,,,..+^4.•^4-•'••^^-.4..��,f,-,--' '4- ` 4 e+n nnn