HomeMy WebLinkAboutMortgage_Shoults M•"''o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township I Year I
d/. ,
any 4 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R71/6-09)
Prescribed by Department of Local Government Finance -
;
INSTRUCTIONS: File
• __. _ .-'
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. AP r
Must be filed with the County Auditor or County Recorder of the county where the property is located Han...,
Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile with the County Auditor of the
county where the property is located during the twelve)12)months before March 31 of each year th- 1, �� �i
deduction is sought GIBBON COUNTY
See reverse side for additional instructions and qualifications. AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Christopher A.Shoults
Taxing District Key number/legal description Record number Pagdngt2RUEpft
Princeton Township 26-12-18-202-002.776-028 /Lot 347 South Side Add. 20130000214* -
A«essed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appruant the sole
March 1.current year March 1.current year date of application legal or equitable owner?
560,918.00 O Yes ❑ No
I If no,what is his/her enact 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 the property in question:Annually Assessed
Ti Real Properly ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American bancorp
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
PO Box 360,Jasper, IN 47547
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other I If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 1 20 20 20 20 20
Sgnature of County Auditor County Date(month.day.year)
I 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 property on date application is filed.
Signature(owne r's full name) Date(month,day,ye
Fug resident address of applicant(number and street,city state,and ZIP code)
914 S.Stormont St.,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 cuue)