HomeMy WebLinkAboutMortgage_McCutchen ...^'. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
"l'' ;% FOR DEDUCTION FROM ASSESSED VALUATION
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N.. State Form 43709(R13/10-15)
\ J- Prescribed by Department of Local Government Finance
INSTRUCTIONS: r F e l k�
To be filed in person or by mail. Forrm,Minty with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. FEB '• NJ[Ald� Auditor
Must be filed or postmarked with the CountyAuditor or County Recorder of the county where the property is tY
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is so % ( , ie�j;
See reverse side for additional instructions and qualifications. GIBcON COUNTY AUDITOR
Applicant(owner or contr ct buyer-see restrictions on reverse skis)
1Thr 1C— U( AC k&e-CC' -10.SCO1 K AND N\GO.uA-chefx Ramon k - PAaC r-
Taxing District r Key number/legal description ) Record number Paber
PRINCETOWN 26-12-07-304-000.742.028 �o l8 _
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the so
assessment dale,current year assessment date,current year date of application legal or equitable owner?
$128,000.00 I?) 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
a Real Property ❑ Mnualy Accessed
Mobie Home(IC 6-1.1-7)
Name of mortgagee or contact seller
OLD NATIONAL BANK
Address of mortga ee or contract seller(number and street,city,state,end ZIP code)
C�`cue Ilvra�n ` vCtnSvl\la Un'l DS
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 n any if yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
ocher county on property for
In Indiana? ❑Yes current year? ❑yes ❑No
A person is not entitled tot 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.
I COUNTY AUDITOR
Deduction approver;in the amount of:
20 20 - 20 I 20_ l 20 20 _ 20
Signature of County Auditor County Date(month,day,yea,)
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.
Signature(owner's full name) n �_ Date(month,day,year)
/ctuan .b/� C J/��f/� bli -V LI2o U �- 02/21/2018
Full resident address of applicant(number and stree city,state,and ZIP code)
625 SOUTH MAIN ST., PRINCETON, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I 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.