HomeMy WebLinkAboutMortgage_Gentry 4.• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION \ q
€'�R\ O��O� �Zd - 2022
j�'tom; State Form 43709(R14/1-20)
File Mark
'14 7 i4-# Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filled in person or by mail. F m 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 County Auditor
property is located on or before January 5 of the calendar year in which the property taxes ae first due ❑ County Recorder
and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jered Gentry
Taxing District 022 Key number 26-12-07-303-002.585-028 Re rd number I Page number
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 o quitable owner?
assessment date,current year Yes 0 No
$18,400.00
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 t property in question: Annually Assessed
Real Property ❑Annually Assessed
FILE Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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 APR 0 7 2022
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) e.14.1464.24)
GIBSON COUNTY AUDITOR
Does applicant ow property in any If yes,what county? What Taxing District? Has this deducti n been requested If yes,state amount of
on property for deduction
other county
in Indiana? Yes ❑ No current year? Yes ❑ No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co ra t 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 i the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Si nature of _ County Date(m nt dam. ear)
9 O ti S 11.0 22--
I/We certify under the penalty o perjury that the above and f re oing information is true and correct and that t e ap licant is a resident of Indiana
and owner/contract b -.of4lie-aforementioned property on e application is filed. Date(month d���yyy,yea/
Sig ature(own e (./1. /�oa�
Full resid address of a scant(number and street,city,state,and ZIP code) J r/
526 S Hall St., Princeton, IN 47670 Date(month,day,year)
Person authorized by duly executed Power of Attorney 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.