Mortgage_Morrison (17) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i' , '\ FOR DEDUCTION FROM ASSESSED VALUATION County Township Year
n
�=/ State Form 43709(R12/6-14)
Prescribed by Department of Local Government Finance - -
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form fled with:
Filing Dates: 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 property is ❑ County Auditor
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 sought.
See reverse side for additional instructions and qualifications.
Applicant(owner a'contract buyer-see restrictions on reverse side)
MORRISON, TODD AND AUDREY
Taxing District Key number I legal description Record number Page number
PRINCETON 26-12-18-102-002.444-028 NAxu$ 2jd Dq P# ao -
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 1I Is the applicant the sole
March 1.current year March 1,current year date of application legal or equitable owner?
68800 60200.00 45787.00 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than s us , di]e wit
1fRI
If name on record is different than that of applicant,indicate below: Is e pro{p�e[rtpyPrm ques0on:naly Assessed
❑ ReaUPN LmR 0 LA6 uaMAssessed
J bile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
GVC MORTGAGE, INC
Address of mortgagee or contract seller(number and street,dfy state.and ZIP code)
One Plaza Dr., Suite 3, Pendleton, IN GIBSON COUNTY AUDITOR
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city.state.and ZIP code)
Does applicant property in any 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 1:1 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 aforementioned property on date application is filed.
Sign re(owner's full name) Date(month,day,year)
odd f e G-if /1
Full resident a ess of applicant(number and street.city,state,and ZIP code)
811 S art St., Princeton, Indiana 47670
Person authorized by duly executed Power of Attomey 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 S10,000. gT