HomeMy WebLinkAboutMortgage_Broshears (3) liaMilla
• i,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshl•
'^�"'':0)., FOR DEDUCTION FROM ASSESSED VALUATION WI
� See Form 4370ff(R14/1-20) Gibson Johnson48
rfPrescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: To be filed in person or by mall. Form filed with:
Filing Date: Fonn must be completed and dated In the calendar year for which the deduction Is sought. 0 County Auditor
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is 0 County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
axing is L.Broshears ( I Pa�q n,shbay-
Taxing DistrictKey number/legal description I U! l�/ly.�
Johnson I26-23-07-400-002.703-024
Aseeased value of real property es of 1 Mortgage I Contract Indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Ilegaf orb bMthe col fl
assessment date,current year assessment date,current year data of application NO
l jot,goo $601, 500 $69.500.00
It no.what Is his/her exact share of Interest? owns ti lh3Ps(f�oap other than spouse,indicate with wham
\\` a the property In question:Annualty Assessed
If name on record h different than that of applicant,Indicate below: t 1 Rea)Property [�Annually Assessed
L Mobile Home(IC 6-1.1.7)
Name of ofcoo mortgagee or contract seller
Evansville Teachers Federal Credit Union
ifie
Address of mortgagee or contract seiner(number and street,city,state,and code)
't'101 Tkw►w bi e. coitus at.., s;i.► 4t-t•'1►5�� ✓y
Name of assignee or other owner or kidder of mortgage -.._2 ssc��� nn�
Address of assignee(number and street,city,state.and ZIP code) Ct4soiy - _, <0���
Does applicant own property in any It yes,what county? What Taxing District? oHas this for It yes,state amount of deduction
in Indiana? ❑Ye 0 No her countyamine p No
A person is not entitled to this deduction unless the person has a balance on the person's mortgag or con ess that is recorded in the county
recorder's office(Including any home equity line of credit that is recorded in the county recorder's o t is th for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor, ,1 County Date(month,day,year)
\C�%-itil LLaS�. 1 �Q l .. u.k;'r+ fY Gibson I"3-'�,tf ..Z
I/We certify under the penalty of perjury that the above ri .� Information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned prope-"--
Signature(owna`afull nema) "5-3 L
``
Full rest Wert address of adpluent(number and street,city,eta f''�
240 E 1200 S.Haubstadt.IN 47639 /8 ka71 /— —
Person authorized by duly executed Power of Attorney or by If �./ Date(month.day,year)
Address of authorized person (number end street,city,state., 20_LP
The penalties for perjury can Include Imprisonment up h...........a.ran years and a fine not to exceed$10,000.
RECEIPT FOR FILING STATEMENT OF MORTGA CT INDEBTEDNESS
Name of applicant N o contract seller
Kassie L.Broshears an Teachers Federal Credit Union
Amount of Inde Taxing District
Date nLted"(month, W-day,year) b°°"1 9. 0t��y �'19, ; son
Kay number I legal description `(74'
26-23-07-400-002.703-024 J
Signature of County Auditor/County Recorder County .�•i. Date(month,day,year)
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