HomeMy WebLinkAboutMortgage_Gregory (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS gaunty Township Year
` r, FOR DEDUCTION FROM ASSESSED VALUATION
1 � 1 02.S 2021
I " State Form 43709(R14/1-20)
Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the itor
property is located on or before January 5 of the calendar year in which the property taxes ae first due 0 County County AuRedcorder
and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Danielle L. Gregory
Taxing District 0 rf) Key number/legal description 26-12-07-304-001.760-028/128 E Monroe Record number Page number
St. Princeton, Indiana 47670 c b M it-7-3 ZD
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 date of application legal or equitable owner?
assessment date,current year E
$136,363.00 l Yes ❑ 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
El Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ILED
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4401 Theater Drive, Evansville, IN 47715 Name of assignee or other owner or holder of mortgage i.)E L 2 2 2021
Address of assignee(number and street,city,state,and ZIP code) '/., ig �
Does applicant own property in any If yes,what county? What Taxing District?n'alI�S` �ajuL'ttkiPbbfa Requested If yes,state amount of
other county on property for deduction
in Indiana? 0 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 co tra 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 ptCounty . d County Date(mont day,yea
I I We certify under the penalty ury that the above�n foregoing information is true and correct and t at applic nt is a residenf of Indiana
and owner/contract buyer of the aforementioned property on date application is filed, Date(month,d year)
Signatur (owner's,fullnn me) ������,-I
\10 o�'oiru Q X�0 ,�'
Full resident address of applicant(numbs and£t'reet,city,state,and ZIP code)
128 E Monroe St.,Princeton, IN 47670 Date(month,day,year)
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7
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.