HomeMy WebLinkAboutMortgage_Burton (5) FILED I) Y
APR 3 0 2019
s«T` Prescribed by Department of Local Government Finance`I 1j,,,, • "/$ I I I -
INSTRUCTIONS: GIBSON17t COUNTY AUDITOR File Mark
To be filed/n person or by mat. Form feed with:
Filing Oates: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 Inunediately 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 Match 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Appian(owner or contract buyer-see restrictions on reverse side)
TIMOTHY J. BURTON , KRISTI R. BURTON
Taxing District Key number/legal description Fteeprd mnb�5r Page camber
Princeton 26-12-06-303-001.110-028/Parkview Pt. L1,2,27&28,B 2 0 s/7 /70 4
Assessed value of real property as of Mortgage I Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
assessment date,avert year assessment date,current year date of appricatlon legal or eqowner?ble owner?
75,702.00 Ugh es 0 No -
11 no,what is his/her exact stare of interest? If owned with someone other then spouse,indicate with whom
if name on record Is ddterent than that of applicant indicate below: Is the property In question:Annually Assessed
gal Property Annuaq'As�ed
�( ❑ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Acceptance Home Mortgage LLC
Address of mortgagee a contract seller(number and sheet city,state,and ZIP code)
101 Plaza E. Blvd. Suite 103, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does apprrant own property in y If yes,what county? What Taxeq District? Has this deducton been requested if yes,state amount of deduction
Other county
❑ curwtaRinIndiana? yes No current ❑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 arrant 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/contract buyer of the aforementioned property on date application Is filed. s//��
Signature(owner's ha name) �l�"nry . n Datet(n�ontA day,;g
F testa ad ss of applicant(number end ,city,sta e,end ZIP )
907 N.2nd Street, Princeton, IN 47670
Person authorized by duly executed Power of Attorney Cr by IC 6-1.1-12-0.7 Date(nanth,day,year)
Address of authorized person(number and sheet 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.