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Home My WebLink AboutMortgage_Keach STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS as County Township Year FOR DEDUCTION FROM ASSESSED VALUATION r ¶ •` State Form 43709(R13/10-15) 1- ,,,;-� Prescribed by Department of Local Government Finance File Mark INSTRUCTIONS: To be filed in person or by mail. CC 9 7 2017 Form fded with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sough 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. /' . El County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County A f%p;i-4 1,, where the property is located during the twelve(12)months before March 31 of eac y s .,s_°aotrR!)!T See reverse side for additional instructions and qualifications. li Applicant(owner or canna buyer-see resmcaons on reverse side) BLADE M. KEACH Taxing District Key number/legal description Record number Page number PRINCETON 26-12-07-203-001.170-028 11 - • S L1 5 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date.current year assessment date,current year date of application legal or equitable owner? $116,784.00 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 A«csed O Real Property ❑ Annually Assessed Mobile Home(1C 6-1.1-7) Name of mortgagee or contract sever ACCEPTANCE CAPITAL MORTGAGE CORPORATION Address of mortgagee or contact seller(number and street,city,state,and ZIP code) 101 PLAZA EAST BLVD., SUITE 102, EVANSVILLE, INDIANA 47715 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 If yes,what county? Wnat 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 Li 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 aforementioned property on date application is filed. at rs NO name) Date(month,day,year) ��. zit 12/ / 9 /2017 ul rear2address of applicant(nurlber and street.city state,and ZIP code) 331 E. STATE 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 310,000. • as STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year Y FOR DEDUCTION FROM ASSESSED VALUATION -(� g 4 '- State Forth 43709(R13/10-15) 1}i JA! ,..,� Prescribed by Department of Local Government Finance —d File Math be INSTRUCTIONS:person or by mai -DEC 28 2017 Form filedwhh: To filed in n pl. Filing Data 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought Must be filed or postmarked with the County Auditor or County Recorder of the county where the. poetry• f •unty Auditor located on or before January 5 of the immediately succeeding calendar year. 7 •i 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the Cou 1444 o*tuff , ., ❑ County Recorder where the property is located during the Melva(12)months before Mardi 31 of each year'eath ..-.t .•;. -.,.,'UC!TOR See reverse side for additional instructions and qualifications. Applita (owner or contact rest//itt iono�nsss o'n reverse side) ilT g District C•e� Key number�c /legal desrn Recud number Page number fil4,3..Cier-J a.to -/A-D? _cz a,.3 -001. 17,0 - o A 8 J?O/ 7 5'IS8° Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole • assessment date,curer year asset date,argent date date of application legal or equitable owner?/` l-' 7? / ❑ Yes 0 N it no,what is his I her exact sham of interest? If arced with someone other than spouse,bldhcate with whom If name on reoud is different than that of applicant indicate below. 1Is.�t,he properly in question:Annually Assessed 5/dal Property ❑ AnnualyAssessed • ll Mobie Home(IC 6-1.1-7) Na of mortgagee or contract seller x!}fnotg �� Address of morlga o seller(number and street city,state,and ZIP cede) C? Name of assignee or other wmeror tdder of mortgage `J`CJ\€ �cuj *a Address of assignee(number and street,city,state,and ZIP code) • F v� Cad � \ �� e_„ rP . rP\ kL -1i({ . p0 Does applicant own property in any If yes,what county? What Taring District? d(T) 1l _ S I-x_)l- (eduction other in Indiana? ❑Yes ❑No 11 • A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contact indebtedness that is recorded in the county recorder's office(mduding any home equity line of audit 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/We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and owner 1 contract buyer of the aforementioned property on date application is filed. xSg' ua.(pwneerArs fuII name) Date(month,day,year) � t address FFFFFF��resderd address o(applicani(number and street city state,and ZIP code) 331 F S+e.---c- Si. Person authorized by duty executed Power of Attorney 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 510,000. •