HomeMy WebLinkAboutMortgage_Pinnick Ems,=F STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
of�y�`y County Township Year
4- ;3'sa,; FOR DEDUCTION FROM ASSESSED VALUATION
f'., P State Form 43709(R12/6-14) Gibson Columbia 2021
%'• Prescribed by Department of Local G vernment Fin nce
es \1/4.1.491
INSTRUCTIONS: AA �l'l e 6031-0Avv\ca
File Mark
To be filed in person or by mail. 1� Form filed with:
Filing Dates: 1) Real Property:Must be completed a dated in the calendar year for which the aeduction is sought.
Must be filed or postmarked with the ounty 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)
Kevin Pinnick
Taxing strict 11 Key number/legal description Record number Page number
0 �� d 26-14-18-303-000.905-007/Tr Add 5 Blk 8, Gibson County 0 on o4 I I(o3
Assessed value of real property as of Mortgage I 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?
$53030.00 I i Yes E 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
Ruoff Mortgage Company, Inc.Address of mortgagee or contract seller(number and street,city,state,and ZIP code) FJLE ik,
1700 Magnavox Way, Ste. 220, Fort Wayne, IN 46804
Name of assignee or other owner or holder of mortgage MAR 19 2020
Address of assignee(number and street,city,state,and ZIP code)
(ei
Does applicant own property in ny If yes,what county? What Taxing District? Has this deductionaistuliosttAnoluI V 1int pf deduction
other county on property for
in Indiana? Yes No current year? ❑El 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(m th d y
110
soil l 10?�
I/We certify under the penalty of perjury that the above and foregoing information is sand correct and that the applicant is reside t of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
,-t. 3/13/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
328 West Dale Street, Oakland City, IN 47660
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. r'
RECEIPT FOR FILING STATEMFre TG NTRACT INDEBTEDNESS f
Name of applicant Nam o age, or contract seller '' ___
Dat !led(month,day,year) Amount of indebtedness Taxing District 1 I
Key number/legal description .�
0(0 -14- IS- YU ) .." 000. 90S -
•
Signaty ofFouunnty ditor/Co a der . '` Date( nth, year
•. GIBSON 0 UNTY^ LIIN 3 n i,vt
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