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HomeMy WebLinkAboutMortgage_Pugh o`ci STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year a _ t, FOR DEDUCTION FROM ASSESSED VALUATION �, State Form 43709(R12/6-14) Gibson Patoka 2020 Prescribed by Department of Local Government Finance INSTRUCTIONS: File Mark To be filed in person or by mail. Form tiled 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 or contract buyer-see restrictions on reverse side) Dusty D. Pugh Tang District Key number/legal description Record number Page number 028 26-12-07-302-002.408-028/Old Plan pt Lot 2, Gibson County 02 o/ g / 7 Q' Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,current year date of application - legal or equitable owner? $112917.00 p Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom It name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed p Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Ruoff Mortgage Company, Inc ILE i1,1 Address of mortgagee or contract seller(number and street,city,state,and ZIP code) r 1700 Magnavox Way, Suite 220, Fort wayne, IN 478 Name of assignee or other owner or holder of mortgage 2U19 MAY 2 Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any If yes,what county? Who;Taxing District? Gign Alginilleited If yes,state amount of deduction other county rc� GIBS@ r' r in Indiana? El Yes Ipl 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 o ,• 8d;;or County1J Date(month,day y ear) c` \ OrN ` 1 G1 I/We certify under the penalty of perjury that the above and foregoin ation i-'-nd correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. Si • re(owner's full name) Date(month,day year) Full resident addr f applicant(numbe d street,city stare,and ZIP code) 224 South Hart Street, Princeton, IN 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.