Mortgage_Syfert 0—ia ; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
d£ 'f FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13I 10-15) Gibson Princeton 2018
\ j Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 0 County Auditor
Must be riled or postmarked with the County Auditor or County Recorder of the county where the ❑ County Recorder
property is located on or before January 5 of the immediately succeeding calendar year.
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 or contract buyer—see restrictions on reverse side)
Matthew L. Syfert , Shannon E. Syfert
Taxing District Key number I legal description R-.e-.numl pet Pagembyr�_
Princeton 26-12-18-403-003.212-028 Ogl IVC CSJ(?
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 1 Is th pplican a sole
assessment date,current year assessment date,current year date of application oil
equitable owner?
18,000.00 195,106.00 Yes 0 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 e property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name ofNavy
rtgagee or contract sellerit 4 Pi
Federal Credit Union 1
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5550 Heritage Oaks Drive, Pensacola, FL 32526 2
Name of assignee or other owner or holder of mortgage NOV 2018
Address of assignee(number and street,city,state,and ZIP code) !]ipCr�/)/ � ----- o
Does applicant own property i any If yes,what county? What Taxing District? Has this deduttroMfePrr'k'I'rh��n.'nl Ir,TYAsy3Yat2 amount of deduction
other county on property for e5re0 11
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/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 I contract buyer of the aforementioned property on date application is filed.
Signature(owners full n e) / Date(month,day.year)
-" 10/31/18
Full resident address of applica Lr-- eft et,city,state,and ZIP code)
301 E Olive Drive, Princeton, IN, 47670
Person authorized by duly executed Power of Attorney or by IC 6-i.1-12-0.7 Date(month,day,year)
Address of authorized person(number and street,city,state,and ZIP code)
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