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Home My WebLink AboutMortgage_Fogg a��. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co� `i i 'r. 4t1 Year ~ ;,.3 FOR DEDUCTION FROM ASSESSED VALUATION 'Er ' "_:t 1� State Form 43709(RD/6-09) Prescribed by Department of Lod Government Finance APRF6 814014 INSTRUCTIONS: To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form Ned with: Filing Dates: 1) Real Property Must file during the year for which the deduction is sought Auditor 2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months before March 31 of each year the deduction is sought. - G I BSO N CO TtarIt.SD1a9ar See reverse side for additional instructions and qualifications. Applicant owner or contact buyer-see restrictions on re rse ) Retold number Page /L.. - ._ c b - /2, - o - 110 d -coo- S 5 - a a-7 a o 13 d.3 cw-s.M value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the app&rant the sole March 1,current year March 1,anent year date of apprkation legal or equitable owner? 59 000 ❑ Yes 0 N If no,what is his/her e>aad share of interest? ' If owned with someone other than spouse,indicate with whom If name on record is different than that of applicant,iodinate below: Is the property in question:Annualy Assessed ❑Real Property ❑AnnuallyAssessed Mobile Home(IC 6-1.1-7) Name of mortgagee«contract seller &11.1 -)-- 7-FL u Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage Add of ' lie(number and sheet coy,state.and code) Drawer NO. l/�V/. a di..... /a.r 7 . MI) Does in Indiana? awn property in any other If yes. t manly.+ NT: �� ` operty county in Incana? ❑ Yes ❑ No Card N O, 0 No COUNTY AUL.__ Deduction approved In the amount of _ . 20 20 20 20 20 20 20 SZ of County Auditor • r County Data(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/contract buyer of the aforementioned property on date application is filed. owner's AS name) Date(month,day,year) n L, / t resident address/�J of applicant(number and street,city,state nd ZIP code) AT -2o7 C /.t)UT .a._... C i- -(re. 1(•..sTTr--4-, L fl). r 7r7n Person authorized by day 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 code) . I INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 fDY.P,REP.ARER -nt.-.----'7-- _ : . tf: -- -- - . . Leon C. Stone President Preparer of the Sales Disclosure Form Title 226 West Broadway Street Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 (812)386-1687 City,State,and ZIP Code Telephone Number E-mail yE-8EliteR(S)' RYANrTDR(g)) . "'7z7�>„• . .ran, t •7--7- --- - .-). - :5 _ . - - . . Paula C Flpers SelieeI-lameeaasappears on conveyance document Seller 2-Name as appears on conveyance document ✓/ld re c s>IJCIA'eet) //J� Address(Numb and S(ree[) ( Address(Number and Street) f }n,Sv, l/ e 47 71 t/y//�y/S,,i/ry7�stat d ode ./ City,State,and ZIP Code 'Telephone—� �� E-mail Telephone Number E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". 0� 9rra— Signaremo(Seller / ter/ Signature of Seller Paula C Elpers /�I, /. (ah/J`t Printed Name o Seller Sla Date(M.7(/DD/Ym7 Printed Name of Seller Sian Date(MM/na/YITYI R(S)%GRAM• S)aTARP,CICATIONIEOWEROPERTiYCTAVDEDUC-TIONSz,IDENTIFYIAIIIITEMS THAVAP,P.LYf 9------7, ' Thomas W. Fogg D Buyer -A'ame as appears on cony yance document Buyell-Name as appears on can�re entE 2e1— Address(Number and Street) Address(Number and Street) Princeton, IN 47670 JAN 3 2n19 City,State,and ZIP Code City,State,and ZIP Code (812)385-8153 Telephone Number - E-mail Telephone Number E-mail THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FO' 'ROPERTY. IDENTIFY A .' ••SE. TY AUDITOR YES NO CONDITION I YES NO CONDITION (;l 0 ❑ 1.Will this property be the buyer's primary 0 0 3. Homestead residence? Provide complete address of primary ❑ Pi • eating/Cooling System residence,including county: 707 East Water Street ❑ 0 5.Wind Power Device Address(Number and Street) 0 0 6.Hydroelectric Power Device Princeton, IN 47670 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County El 2.Does the buyer have a homestead in Indiana to be ❑ 0 8.Is this property a residential rental property? vacated for this residence? If yes,provide ❑ 0 9.Would you like to receive tax statements for this complete address of residence being vacated, property via e-mail?(Provide contact information including county: below.Please see instructions far more information. Not available in all counties.) Address(Number and Street) 2 l/p —City,State VP Code ` rl z-o7_�2 -ca. 7g-o�cl Ci County Primary property owner contact name E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being fi .) /i,- C Signature of Buyerl Signature of Buyer2/Spouse Thomas W Fogg I L. Z C-Zo,k Printed 1. al Name of I �\ ` �5�\ 41/DD/YYYY) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/DD/YYM 1°5 Last 5 digits of Buyer l Driver's State Lost S Digits of Social Security Number Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security License/ID/Other Number Number License/ID/Other Number INDIANA SALES DISCLOSURE FORM SDF ID: Page 2 y(DrP,REI ARERi " `7--v, z - f. . . c.- _ ..- -- 1 Leon C. Stone President Preparer of the Sales Disclosure Form Title . 226 West Broadway Street Broadway Title, Inc. Address(Number and Street) Company Princeton, IN 47670 (812)386-1687 City,State,and ZIP Code j Telephone Number E-mail ETSELCER(SAG AN:TAR(S)1 -7t-- • -- 5'-. .;• it-aj N!4— `-7 .). �'¢L f- 2: - Paula C Elpers sA/Sne, I-Name as appears on conveyance document Seller l-Name as appears on conveyance document ✓k;DI .Xr.c �d_ gqddd'ress(Numbe andSsreet) - Address(Number and Street) lips: 1AVIlie_ '*77 / /a, certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.5,"Real Property Sales Disclosure Act". �� G Signature of Seller l y/ Signature of Seller Paula C Pipers 1/_ , £' /a,Q/a Printed Name ofSeller Sia Date(M.$$$/OD/Yrvh Printed Name of Seller Sian Date(MM/DD/1'm) WER(Sf/.GRANlitEgS WAPP,LIGATIONWOR'P,ROP,ERVLTAX?DEDUGTIONS IIDENTIFY(.ATLyITiEMSMIATLTAP,P.-L'Ys `?. P—``' - BThomasrI- am, Fogg appears ''jT�� D Buyerl-Nomeatappeart on ronv yance document Buyul-Nameas appears on toff qx en[ E Address(Number and Street) Address(Number and Street) llI{LL� JpL Princeton, IN 47670 JAN 3 1t119 TO APPLY FOR CERTAIN DEDUCTIONS FO' 'ROPERTY. IDENTIFY A s• •ISE. TY AUDITOR GI: YES NO CONDITION YES NO CONDITION Vi El 1.Will this property be the buyer's primary IZI ❑ 3.Homestead residence? Provide complete address of primary • ❑ �� -eating/Cooling System residence,including county: 707 East Water Street ❑ � 5.Wind Power Device Address(Number and Street) ❑ WI 6.Hydroelectric Power Device Princeton, IN 47670 Gibson ❑ 0 7.Geothermal Energy Heating/Cooling Device City,State ZIP Code County ❑ 0 2.Does the buyer have a homestead in Indiana to be El 0 8. Is this property a residential rental property? vacated for this residence? If yes,provide 0 IL 9.Would you like to receive tax statements for this complete address of residence being vacated, property via e-mail?(Provide contact information including county: below.Please see instructions for more information. Not available in all counties.) Address(Number and Street) 24-/z o7-4 2. -Ira gig-Dill City,State ZIP Code County Primary property owner contact name E-mail Under penalties of perjury,I hereby certify that this Sales Disclosure,to the best of my knowledge and belief,is true,correct and complete as required by law,and is prepared in accordance with IC 6-1.1-5.S,"Real Property Sales Disclosure Act".(Note: Spouse information,Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being fi .) ' (jlc, 2—s Signature of Buyer! Signature of Buyer2/Spouse Thomas Fogg I1-• Zg.-20it Printed Legal Name of Buyer 1 Sign Date(MM/DO/rvr1) Printed Legal Name of Buyer 2/Spouse Sign Date(MM/o0/Wrq Last 5 digits of Buyer l Driver's State Last 5 Digits of Social Security Number Last 5 digits of Buyer 2/Spouse Driver's State Last 5 Digits of Social Security License/ID/Other Number Number License/ID/Other Number