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Home My WebLink AboutMortgage_Smith (35) sn, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township Year T t FOR DEDUCTION FROM ASSESSED VALUATION s Slate Form 43709(RIO ) FILE awn Princeton � � Prescribed by Department of Local Government Finance 1��/J INSTRUCTIONS: File Mark To be filed in person or by mail with the County Auditor of the county where the property i(JEtatcS 2013 Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mo the before March 31 of each year the deduction is sought. �1�Id/1CA See reverse side for additional instructions and qualifications. r—'-- f71TOR Applicant(owner or contract buyer-see restrictions on reverse side) Regina Gail Smith AU GIBSON COUNTY Taxing District Key number r legal description Recortldn Im - Pegg numb4r I Princeton 26-11-12-301-001.618-028/Lot 29 Broadview Sub CC��JJ1tt l,� 5U( JL Assessed value of real property as of Mortgage/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? 78,000.00 13 Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom II name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed ©Real Property ❑Annually Accessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Address at mortgagee or contract seller(number and street.city,sate,and ZIP code) German American Bancorp Name of assignee or other owner or holder of mortgage P.O.Box 360,Jasper, IN 47547 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 on property county in Indiana? for current year? ❑ Yes ❑ No ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount of: 20 20 20 20_ 20 20_ 20 Signature of County Auditor County (Date(month,day,year) 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 I contract buyer of the aforementioned property on date application is filed. 1,Iy Sign +'(own I(ry*loam ` t, AUG(3 0 d�V f ) Full reside rx'dress of applicant(number and street.city,state,and ZIP code) 112 Broadview Circle Dr,Princeton, IN 47670 Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year) Address of authorized person (number and street.thy,state,and ZIP code)