HomeMy WebLinkAboutMortgage_Quillen ;K e- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
u� l FOR DEDUCTION FROM ASSESSED VALUATION
Gibson 2019
F,.ern rOg 4F€13?10-9si Princeton
Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed 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 flied or postmarked with the County Auditor or County Recorder of the county where the property isIZCounty Auditor
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 ❑ County Recorder
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)
Brandon T.Quillen
Taxing District Key number/legal description Record number Page number
Princeton 26-12-06-401-001.482-028/NORTHBROOK HILLS 27 2-t tq 5038
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?
$0.00 $176,276.00 0 Yes ❑ 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 the property in question:Annually Assessed
x❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Ruoff Mortgage Company, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FILED
1700 Magnavox Way, Suite 220, Fort Wayne, IN 46804
Name of assignee or other owner or holder of mortgage
DEC 11 2Q19
Address of assignee(number and street,city,state,and ZIP code)
D ' 1t Oran sn property fn� If yes,what county? What Taxing District? Has tilt edk:C'l "e Ef e €ested If yes,state amount of deduction
�tY�eJ"i0x r-�for or
i13 0:�a ❑Yea LJJ No 1
GI zE7tU YeAU>
.4 person is not entitled to this deduction on unless the person has a balance on the person c mo;ti?age or contract indebtedness that is recorded in the county
recorders office(including any home equity line of credit that is recorded in the county recorder's office)mat is me heats for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Count Auditor County Date(month,day,year)
Srnl Gibson •
I/We certify under penalty of 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 pro rty on date application is filed.
Date(month day ear)
Signature(owner'sTulCname)�_; �- 2 ,e,1.3�C
Full resident address of applicant(number and street,city,state,and ZIP code)
1502 Cottonwood 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 palmy can ins/tide imprisonment up to two and a hair years and a fine not to exceed Si.00{0.