HomeMy WebLinkAboutMortgage_Davenport (2) CDSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township n Year I
FOR DEDUCTION FROM ASSESSED VALUATION �� I rFl� 2022 I
State Form 43709(R14/1-20) File Mark
Prescribed by Department of Local Government Finance
INSTRUCTIONS: Form filed with:
D To befilled person mail.
Filing Dates:: Form must mustst 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)
Timothy Davenport
e number
Taxing District Key number 26-14-18-301-000.068-007 „�ad �_ /AJ7� aO�
CI
Record number (Pag ��c'
IifO co. CDiiunb/4. 5t, li`-'
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of(date of application Contract indebtedness unpaid as of Is legal a equitable the
e sole
assessment date,current year assessment date,current year Yes El No$80,275.00
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
cant,indicate below: P/t Is t question: AnnuallyAssessedIf name on record is different than that of appli I
dalproperty Propertyin ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 40,0 471)
Evansville Teachers Federal Credit Union 2 y
Address of mortgagee or contract seller(number and street,city/ nd ZIP code) ZO<,
4401 Theater Drive, Evansville, IN 47715 SoN� Z
4/
Name of assignee or other owner or holder of mortgage C/ T .G�
Address of assignee(number and street,city,state,and ZIP code) R
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction een requested I If yes,state amount of
other county
on property for deduction
current year? Yes ElNo
in Indiana? 0 Yes No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or tra 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) at is he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
I 20 I 20 I 20 I 20 I 20 I 20
20
Signature of County Auditor ,.�r� Count (Date(month,day,year)
/� I
ek Q a4\tlLr s / t 5+-f-- Lk.— >—1 —2l0 Z Z_
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana
and owner/contract buyer of the aforementioned on date application is filed. Date(mgq��th,da/y year)
Signature•(owne's full;,;:e) J Li ?a- aop)a
Full resident-'�ess of applican ofm•er and street,city,state,and ZIP code) II /
430 W Columbia St., Oakland City, IN 47660 (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.