HomeMy WebLinkAboutMortgage_Leible STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
aI ' f State Form 43709(R13/10-15) Gibson 201 9
• Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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 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)
Daniel/Dorena Leible
Taxing District Key number/legal description Record number Page number
Princeton 26-19-19-103-001.192-026 2019 4899
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?
184000 I] Yes El 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
ID Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Carrington Mort
Address of mortgagee or contract seller(number and street,c _
Name of assignee or other owner or holder of mortgage �6�� �
DO4e.,vn- e
Address of assignee(number and street,city,state,and ZIP c
Does applicant own property in any If yes,what county? __. 8qc:1 sted If yes,state amount of deduction
other county
in Indiana? ❑Yes 0 No 111 ]No
A person is not entitled to this deduction unless the per 5tedness that is recorded in the county
recorder's office(including any home equity line of crew,<„o,,. ,,,II IC tAlu,ny r ccuruei s urrwr/trrar is me oasis 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)
W^'"d G'• -• - 3 01/29/2020
I/We certify under the penalty of perjury that the above and foregoing informati"i '} tr cor fl ant the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is file•.:
Signature(owner's full name) Date(month,day,year)
JAN 2 9 2020 01/29/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
7982 S Andee Lane, Fort Branch, IN 47648
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
GIBSON COUNTY AUDITOR
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.•
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Daniel/Dorena Leible Carrington Mort
Date filed(month,day,year) Amount of indebtedness Taxing District
01/29/2020 184000 Princeton
Key number/legal description 26-19-19-103-001.192-026 2 t kit 8 f q
Signature of County Auditor/County Recorder County Date(month,day,year) '
��„n;,1t-, c� Gibson 01/29/2020