HomeMy WebLinkAboutMortgage_Coomer (7) ,^ '':' • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
3 FOR DEDUCTION FROM ASSESSED VALUATION
'' State Form 43709(R14/1-20) Gibson Fate 2022
iai• ` Prescribed by Department of Local Government Finance it
\ File Mark
INSTRUCTIONS: To be filed in person or by mail. c_0/ Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. U XCOunty 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. tgEtCounty Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ryan Coomer and Amy J. Kelley
Taxing District O nCJ Key number/legal description Record number Page number
S Swallowfield— �/- 26-12-06-203-003.986-028/Tract No. 19 Swalloweld 2(A-140) yo2 " I Li I3
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 legakorquitable owner?
$206,600.00 $205,000.00 MYes ❑ 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: FILED the Real propertyProperty in question:
Annually Annually Assessed
❑ Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Evansville Teachers Federal Credit Union MAR 3 0 2022
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4401 Theatre Drive, Evansville, IN 47715 �/���
Name of assignee or other owner or holder of mortgage ./�,� a. ^^'^""
GIRSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property any If yes,what county? What Taxing District? Has this deducti en requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes 0 No
A person is not entitled o this deduction unless the person has a balance on the person's mortgage or c 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)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 ` ,3 _ (�� County Dat onT-to`22-
1 ,day,year
W , �(�5 �J1 Gibson ,2/We certify under penalty of perjury that the above and foregoing information is true and correct and that the applicant is a sidenof Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ature ner's �ame) ,7te_g_45Date(month,day,year)
Full ident address of applicant(number and street,city,state,and ZIP code)
1701 Martin Lane, Princeton, IN 47670
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 imprisonment up to two and a half years and a fine not to exceed$10 nun