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.di ". STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
1 FOR DEDUCTION FROM ASSESSED VALUATION Gibson Columbia 2022
' State Form 43709(R14/1-20) RECEIVED
r. Prescribed by Department of Local Government Finance1 f
ile Mark
INSTRUCTIONS: To be filed in person or by mail. A UG 1 1 2022 Fo filed with:
Date: Form must be completed and dated in the ca dar year for which the deduction is sought. CountyAuditor
Filing p
Must be filed or postmarked with the Coun uditor 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 are first due and payable. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Wayne R. McDaniel
Taxing District Key number/legal description Record number I Pager
Columbia 26-14-19-203-001.050-006/Pt SW NE 19-2-8(.89 A) '�2-Z" 3
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 assessment date,current year date of application lega or equitable owner?
$101,500.00 $147,250.00 es Cl 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: T I e property in question:Annually Assessed
Lsal Property ❑Mnnuelly Aseessed
Mobile Home(IC 6-1.1-7)
r Name of mortgagee or contract seller AUG 1 1 f` 1 y 2022
Evansville Teachers Federal Credit Union 1
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /
4401 Theatre Drive, Evansville, IN 47715 .dtceC a. .Ilea)
Name of assignee or other owner or holder of mortgage GIBBON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own props in any If yes,what county? What Taxing District? Has this deducti be requested If yes,state amount of deduction
other county on property for Yes El No
in Indiana? ❑Yes O current year?
A person is not entitled t this deduction unless the person has a balance on the personas mortgage or contra 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 20 20 20 20
Signature of County Auditor in vOdittAvAls
County D e mo h year)
I Gibson
i/We certify nder p-na • ,,u at the above and foregoing information Is true and correct and that the applicant Is a idefit of Indiana and
owner/contrac • h- - e• coned property on date application is filed.
Signature(owner's Iv =y ( Date rimer)
%
Full resident adof aplicant •street,city,state,and ZIP code)
1812 S 12 r. E, Oa and C k. •7660
Person authorized by dui executed Po er of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized rson(number= d street,city,state,and ZIP code)
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