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,...^--po STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12/6-14) g)
,• ,• Prescribed by Department of Local Government Finance I®SI'I LE!
INSTRUCTIONS:
To be filed in person or by mail. n 5io ed with:
Filing Oates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. MAY 2 J •1u
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. all . Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must fife with the County Auditor of the co r (, , 2r.ht
where the property is located during the twelve(12)months before March 31 of each year the deduction i; �¢ 'OU NTY AUDITOR
See reverse side for additional instructions and qualifications. 55
Applicant(owner or contract buyer-see restrictions on reverse side)
BRADLEY W. STONE
Taxing District Key number/legal description R_yc�r l number Pa�e�aL cer�
PRINCETON 26-11-12-304-001.618-028 �JJ�/��1 Le 11
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1.current year date of application legal or equitable owner?
171,200 132,554 p 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
TA Real Property ❑ Annually Assessed
Mobile Home(IC 6.1.1-7)
Name of mortgagee or contract seller
MORTGAGE MASTERS OF INDIANA INC
Address of mortgagee or contract seller(number and street,city state.and ZIP code)
501 N CROSS POINTE BLVD EVANSVILLE IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.crry,state.and ZIP code)
Does applicant own property in yy If yes.what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in.Indiana? ❑Yes No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract 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 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 aforemention-. . .perry on date application is filed.
Sgry[y!lVV��re ell )/ �(Q Date(month,day,year)
!/
05/11/2016
Full resident addres a••leant(nu •-r a •street,ciryhs ate,and ZIP code)
112 S B-0 'VIEW CIR DR PRINCETON IN 47670
Person authorized by duty executed Power of Anomey or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city.state.and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.