HomeMy WebLinkAboutMortgage_Blythe (3) •'. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 - FOR DEDUCTION FROM ASSESSED VALUATION ` `��
', q_Nov\ O 2022
2 't State Form 43709(R14/1-20)
"�-_' �� File Mark
'R„ �' Prescribed by Department of Local Government Finance
ram.
INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates: Form must be completed and dated in the calendar year for which the deduction is sought. AC
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
and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Matthew Blythe and Jamie Blythe
Taxing District Key number/legal description 26-23-07-200-002.432-024/223 E Hirsch Record number Page number
OZ Woods Ln. Haubstadt, Indiana 47639 /q�
a
26-23-07-200-002.432-024 �6�
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the
applicant
e the owner?sle
assessment date,current year assessment date,current year date of application 9h
$363,300.00 es 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 belq "LED Is the grope n question: Annually Assessed
Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 2 2 2022
Evansville Teachers Federal Credit Union APR
Address of mortgagee or contract seller(number and street,city,state,and ZIP code),
4401 Theater Drive, Evansville, IN 47715 ��1 �( 1 Y/Ap,OCATOP
Name of assignee or other owner or holder of mortgage Gt2SON COUNT
Address of assignee(number and street,city,state,and ZIP code)
C --0
Does applicant own property in any f yes,what county? What Taxing District? Has this.educion been requested If yes,state amount of
on property for eduction
other county
in Indiana? ❑ Yes 0 current year? Yes ❑
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or co tr t indebtedness th 's 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
County _(- Date(mo; „{ta ,yea ��Signature of Co Auitor _/ J4_,SCI ` ILI/We certify under the penalty of perjury that the above andoing information is true and correct and that a applic nt is a resident of Indiana
and owner/contract buyer of the aforementioned property o application is filed. Date( nth,dai year) -�/
lit ,
Sign e,�(owner;�,fame) DG a
Full re ent address of applicant(number and street,city,state,and ZIP code)
223 E Hirsch Woods Ln., Haubstadt, IN 47639
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.