HomeMy WebLinkAboutMortgage_Smith (17) dam"=nA STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ' County I Township I Year
h FOR DEDUCTION FROM ASSESSED VALUATION
State Form 63709(R17/5-09) Gibson �I � ok
� '•' Prescribed by Department of Local Government Finance I e '
INSTRUCTIONS: .ley
To be filed in person or by mail. F0R°fi :2 8 20 3
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. Q
Must be filed with the County Auditor or County Recorder of the county where the property is located County Auditor
on or before January 5 of the immediately succeeding calendar year. Coun -r
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the /,.r,• 'y!T�/r
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Henry P.Smith
Taxing Disthct Key number I legal description Record number Pag nummbbeer
Gibson 26-12-32-200-004.065-027 Instrument
a11n11(1 lTnnnn3s17 .
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1.current year date of application legal or equitable owner?
161,400.00 180,000.00 220,000.00 fl Yes ❑ 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: Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First Financial Bank
Address of rnortgagee or contract seller(number and street city,state.and ZIP code)
One First Financial Plaza,Terre Haute, IN 47808
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 If yes.what county? What Taxing District? Has this deduction been requested an property
county in Indiana? for current year?
❑ yes 0 No 12 Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Auditor /1 County Date(month.day,year)
r '
I%We certify under t e 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(owner's full /1 Date(month,day,year)
II((gg�re>�VII�I Y)tI/'
4/29/2013
Full sident ad s of applicant(number and street,city,state,and Zl.a code)
1o077 E.350,Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city state,and ZIP code)