HomeMy WebLinkAboutMortgage_Groves (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS sI P L, s IL Year
1 FOR DEDUCTION FROM ASSESSED VALUATION J ice'
State Form 43769(R13/10.15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: -41A
2File/f�idflc
To be filed in person or by mail. Fo filed - :
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. •
Must be riled or postmarked with the County Auditor or County Recorder of the county where the prop County Auditor
located on or before January 5 of the immediately succeeding calendar year. r���ppCON COUNTY E p s1rtt fecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audirol br the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
EARL G. GROVES & PEARL E. GROVES
Taxing District Key number/legal description Record number Page number
PRINCETON 26-12-07-402-001.466-028 aO t — `3M
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date.anent year assessment date,current year date of application legal or equitable owner?
$111,000.00 El 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
Fl Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgage or contract seller
ACCEPTANCE CAPITAL MORTGAGE CORPORATION
Address of mortgagee or contract seller(number and street,thy,state,and ZIP code)
101 PLAZA EAST BLVD., SUITE 103, EVANSVILLE, INDIANA 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code)
Does applicant own property in/ny If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,--, 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 I 20 20 I 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 aforementioned property on date applicatio is filed.
`Signat re(or e/s Date(month,day,year)
12/ 'L ( /2017
Pull resident address of applicant(number and street,city.state,and ZIP code)
302 S. STOUT STREET, PRINCETON, INDIANA 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 code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed 810,000.