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HomeMy WebLinkAboutMortgage_Campbell (6) M STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESScounty Township Year °i a FOR DEDUCTION FROM ASSESSED VALUATION 7J. Cod �2Z xn A State Form 43709(R13/10-15) ,,.SC)or)`'+ a Prescribed by Department of Local Gov rnment Finance r ` File Mark INSTRUCTIONS: \` / e` F rm 'ed with: Toi be ad in person or bro mail. J C Filing Dates: 1) Real Property:Must be completed an d ted in the calendar year for which the deduction is sought. County Auditor Must be filed or postmarked with the C unty Auditor or County Recorder of the county where the property is located on or before January 5 of the immediately succeeding calendar year. County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Campbell, Kr stal D. & Campbell, Eric S. Keynumber/legal description Reggor number Page number Taxing District 9 ���\��:� 3 Haubstadt 26-18-36-403-000.661-009 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of date of applicatione/ ntract indebtedness unpaid as of Is legalthe or applicant li aabl equitablethe sole er? assessment date,current year assessment date,current year$232,855.00 ❑ Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom FIT FS e property in question:Annually Assessed If name on record is different than that of applicant,indicate below: eL Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller i Evansville Teachers Federal Credit Union JUL 0 7 2022 Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 4401 Theater Drive Evansville, IN 47715cC J t �,z� Name of assignee or other owner or holder of mortgage GIBSON COUNTY AUDITOR Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has this deducti n een requested If yes,state amount of deduction other countyp�l on property for NO in Indiana? ❑Yes "KIN() current year? ' Yes A person is not entitled to this deduction unless the person has a balance on the person's mortgage or ntract 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 offic ) at is the basis for the deduction. COUNTY AUDITOR Deduction approved in the amount of: I 20 I 20 I 20 20 I 20 20 20 IL Cq-9ICountyI Date(month, a�ye )Signature of CountyAu r �©'� _T/— �2Z— I/We certify under the penalty of perjury that the above and foregoing information is tr d correct and that the applicant is a eside t of Indiana and owner/contract buyer of the aforementioned property on date application is filed. I Date(month,day,year) Js�gnatu (owners full name) 07/01/2022 Full resident aaidiress of applicant(numbe and street,city,state,r4nd"ZIP code) 1004 Monica Court Haubstadt Indiana 47639I 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.