HomeMy WebLinkAboutMortgage_Roy (2) �0..71, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCountyTownship
41 `s FOR DEDUCTION FROM ASSESSED VALUATION YearC (R12 ) Gibson Patoka 2021
��� State Form 43709 /6-14
„'4 , Prescribed by Department of Local Government Finance
INSTRUCTIONS: 7(u.-1s lI IM CI
I—( I (1. HI /r.3�p?a File Mark
To be filed in person or by mail. I�,IJ� 1 �(,V► W I �Q 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)
Patricia A. Roy
Taxing District Key number/legal description Record number Page number
028 26-12-07-302-002.892-028/ Old Plan 1 Pt, Gibson County Cy 00 tost4
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?
63660.00 E 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
❑✓Fir,EReal Property III 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)
1700 Magnavox Way, Suite 220, Fort Wayne, IN 46804 MAR
Name of assignee or other owner or holder of mortgage 2020
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUt�(( pp
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been rre-gL�ePe�T�'.-yes,state amount of deduction
other county on property for
in Indiana? Yes 111 o current year? ❑
El Yes LI 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 0 20 rib, , 20 20 20 20
Signature of County Au for County Date( nth, a,year)
G
I/We certify under enalty of perjury th- - above and foregoing information is true and correct and that the applican is a esident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
—_ S' natu a cowrie Lull.name) / _g _ __ _ 'Date(month,day,year)__
.�.t,f�.1 ) 6 t 2/25/2020
Full resident address of applicant(number a 0-et,city,state,and ZIP code)
241 South Hart Street, Princeton, IN 47670 •
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(mo y, )
3O
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 F , 'AG ; CV:•CT INDEBTEDNESS
Nam f applicant 4 Na o rj rt a ".ntract seller
Dat fed(month,year) �t{��"f)J l�� Amount of indebtedness T �PP,�ict
:- 13-1,02� Le Li(oO MAR 13 2020 ��l
Key number legal des r n
9)119.b 1 't►, j I U9g--G n 1 rl1rd O n t 7 J+"
Signaturgyf CosMu li,./ .unty_Rgc yer GIBSON ' rr , sK5 Date h,da O�
l`� � l/,'` �1, � � �3 GGG