HomeMy WebLinkAboutMortgage_Grogan pa*0 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County _ Township ' Year
1. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R131 10-15) 2019
't'o .1Prescribed by Department of Local Government Finance File Mark
we
INSTRUCTIONS:
To be filled in person or by mail. Form filed 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 located on or before January 5 of the immediately succeeding calendar year. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ❑ County Recorder
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)
Nicole A.Grogan
Taxing District Key number/legal desyriptiof 26-12-27-200-004.107-027/ Record number Page number
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$155,555.00 1pXes ❑ No
If no,what is his I 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
6a1-eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �� it
N.Cross Pointe Blvd., Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) JUL 08 2019
Does applicant own property in any If yes,what county? ,at Taxing District? Has this deduction been r quested If yes,state amount of
other county on pro r•
NTY AUDITO deduction
in Indiana? El Yes ❑ No ( oc- ❑ No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness tR
hat 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 I 20 ?0 20_ 20 20
Signature of Coun udito County Date(moot , ,y tot
1/We certify u p yof penury t above and foregoing information is true and correct and that the pli t resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sig ture(owner's full name) Da (month,day,year)
ull resident address of applicant(n rand street,city,state,and ZIP code)
2723 S 350 E, Princeton, IN 4 670
Person authorized by duly executed Power of Attorney 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.