HomeMy WebLinkAboutMortgage_Scales Sr ■r. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•tom FOR DEDUCTION FROM ASSESSED VALUATION i
!L \n' 7 0 2_ l State Form 43709(R14/1-20) 3- � T - 2022
N►� / Prescribed by Department of Local Government Finance File Mark
,Ii
INSTRUCTIONS:
To be filled in person or by mail. Fo 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
property is located on or before January 5 of the calendar year in which the property taxes ae first due County Auditor
and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Randy Scales, Sr.
Taxing District^ Key number 26-12-19-200-001.311-027 Record number Page number
Laaa-D--. IU Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app nt the sole
assessment date,current year assessment date,current year date of application legal o quitable owner?
$184,000.00 Yes ❑ 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 e property in question: Annually Assessed
Name of mortgagee or contract seller FILED Real Property El Annually Assessed Mobile Home(IC 6-1.1-7)
Evansville Teachers Federal Credit Union
Address of mortgagee or contract seller(number and street,city,state,and Zyde0 7 ZOZZ
4401 Theater Drive, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage Yj,, 'A/�J
/Lzch2G/ a Ili4 6;nd)
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUN I Y AUDI I OR
Does applicant own property in any If yes,what county? What Taxing District? Has this dedu ion been requested If yes,state amount of
other county on property for deduction
in Indiana? 0 Yes VAo 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 tr 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 is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 _ 20 t20 20 20 20
Signature of County Auditor County Date(month d e 2
ML3 �►ram sot\ L.\ �Lo2
1/We certify under the penalty of perjury that the above and fQrQgoing information is true and correct and that the a pli nt is a resident of Indiana
and owner/cont ct buyer of the aforementioned property on ate application is filed.
$igpiature(own ull name) Date(mon h,day, r)
? � 2 3/3O/ c
Full re - ent address of ap`cant(number and street,city,state,and ZIP code)
252 E 200 S, 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$10,000.