Mortgage_Perry (12) ,4-.T.T STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESSCountyTownship
o`er ���t Year
FOR DEDUCTION FROM ASSESSED VALUATION p)
Y', ,�3c -ia
E :. State Form 43709(R12/6-14) Gibson Patska.. 2021
%•,si e,a` Prescribed by Department of Local Government Finance
(11 1�
INSTRUCTIONS: '? h.tI( ,, — &44) 1 10. �`a1C 3/13170 03 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 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)
Ryan Perry Jr.
Taxing District Key number/legal description Record number Page number
028 26-12-07-202-000.162-028/PT NE 7 2 10 .296 AC, Gibson County 90a0 0600 n�c�Ci
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant a ssooie
March 1,current year March 1,current year date of application legal or equitable owner?
134343.00 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
❑✓ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Bank of England ,�.�
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �!
PO Box 3490, Little Rock AR 72203 F IL )
Name of assignee or other owner or holder of mortgage
MAR 13 2020
Address of assignee(number and street,city,state,and ZIP code)
'^------
Does applicant own property in any If yes,what county? What Taxing District? Has this de ''7ysted If yes,state amount of deduction
other county o .•_ctt '' 'DITOR
in Indiana? ❑Yes -, No c s��r �9yT
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 Au , • \,1r Coun Date month, y,year)
I/We certify under the penalty of perju the above and foregoing information' ue and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner s full ' L(� / . - Date(month,day,year)
��// 2/28/2020
Full resident address of-0:icant(number and street,city,state,and ZIP code)
830 East Oak Street, 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.
RECEIPT FOR FILING STATEMENT OF MORTGAG !; C C. TRACT INDEBTEDNESS
s
Name of applica ar9
f�• N ofineii:-g'•o�bntra,•se'er;,. ;J G i f, 114 P # ''f 44'Date file (mon day,year) AIM. of ind to s a n Di tri
3• 1 -202-0 • - 1 ► �� MAR 1S2 k� 202�= 06(g2 .
Key number/legal descriptio f�
f2, 0. '20vdoo - 1cpa - 0
Signature of County Auditor/ •u - order County \�II�c Date(month,day, ear)
S. , '�'� ' GIBSON COUNTY AUDITOR 3• 12• Lo2 0 .