HomeMy WebLinkAboutMortgage_Ritchey -otsr4 .q. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t ''),... FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14/1-20) RECEIVED Gibson 02_5 2021
Prescribed by Department of Local Government Finance
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..- - 'JAN 0 4 2022 File Mark
INSTRUCTIONS: To be filed in person or by mail. .3....SC....---- Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. IZI 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. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Dakota Ritchey and Shelby Forston
Taxing District " Key number/legal description 1 Record nurpyr1 Page number
Fialtlafefleil LA-41.(A:7T's 26-19-08-200-000.079-025/PT SW NE 8 3 10 1.50 AC
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app cant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$0.00 $304,000.00 [Kees 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: FIT F, D Is t proorpertroyprtY inequestion:Ar=Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union JAN 0 5 2022
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 tihr.clietzx :_•-f--• .-7-:,, .,...,,
GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deductiii i •fen requested If yes,state amount of deduction
other county 0 es 0on property for -,
r Y 0 es No
in Indiana'? current year?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or.•n. -ct 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)tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 i 20 Gib 1 20 20 20
of
Signaturet -... County 57.17)
Date ,
neWAAV)-1 son
I/We certify under penalty of perjury that the e and foregoing information is true and correct and that the applicant is a r side of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
e er's full name Date(intsray,yea 34
..---- V.,Si4-1ii 64, -•,----
Full resi ent address of a lican (number and street,city,state,and ZIP code)
5894 S. 100 E., Fort Branch, IN 47648
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 1 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.