HomeMy WebLinkAboutMortgage_Gerlach CSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C ,unty Township Year
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1111.) FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) �/� 2021
Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS:
To be filled in person or by mail. Form f led 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
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)
Jenne Gerlach
Taxing District Key number/legal description 26-18-26-300-001.893-025/9293 S 225 W Record number Page number
0(),,,) Fort Branch, Indiana 47648 0
26-18-26-300-001.893-025 O((ORr r 6Sq
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant sole
assessment date,current year assessment date,current year date of application legal or equit e owner?
$164,000.00 Ye ❑ 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 p petty in question: Annually Assessed
al Property ❑Annually Assessed
Fi-
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Er)
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) DEC
4401 Theater Drive, Evansville, IN 47715 2 R 2n,
Name of assignee or other owner or holder of mortgage
GIRgO �
t
Address of assignee(number and street,city tate,and ZIP code) N COt1NT
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu or�eerTl�quested If yes,state amount of
other county on rty for deduction
in Indiana? 0 Yes 0 Yes ❑
A person is not entitled to this deduction unless the person has a balance on the person'scxcar?
o t act debtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county reco er )t t is th 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)
I/We rtify under the penalty of perjury that t e above and foregoing information is true and correct and that the applicant is a resident of Indiana
and owner/contract bu er of the aforementioned property on date application is filed.
Si e(owne ull nam Date(month,day,year)
1 -,W"
Full resid address of applicant(number and street,city,state,and ZIP code)
9293 S 225 W, Fort Branch, IN 47648
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)
Ti.,nonalties for neriury can include imprisonment",..*,-•••- -