HomeMy WebLinkAboutMortgage_Cundiff (3) Em'4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.I/ - = ' FOR DEDUCTION FROM ASSESSED VALUATION
fitt t'`''`;'
s State Form 43709(R13/10-15) Gibson Princeton 2019
� ,_:-•
v-:ie��e .:- 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. X County Auditor
Must be filed 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-
Taxing District Key number/legal description Recordrd l ,,1 ryp 3er Page nu
Princeton 26-11-12-301-000.160-028 111
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?
$108,200.00 152,683.00 ❑ Yes 0 No
If no,what is his(her exact share of interet? - If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: s property in question:Annually Assessed
Real Property 0 AnnuallyAssessed -
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) •
. FILED
501 N. Cross Pointe Blvd, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage 1, L 01p q
SEP J
Address of assignee(number and street,city,state,and ZIP code)
. Q
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been re Barb IfLyeut
�jr rynitlIgtion
other county on property for l�lo
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)
%Yeik 14 i4Vsan °I-A-lq.
I/We certify under the penalty of perjury that the above and foregoing information 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.
Signaturrr wner's full nam Date(month,day,year)
u 'dent applicant er and street,city,state,and ZIP
PP ( code)
111 S Broadview Ci e Drive, Princeton, IN, 47670
-
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$10,000. 43013 •