HomeMy WebLinkAboutMortgage_Livermore (5) S,,g RA,` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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• gl" ,`.`l�� State Form 43709(R14/1-20) ,�'0" 1 2
°� %�' Prescribed by Department of Local Government Finance R C� as -D
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File Mark
INSTRUCTIONS: To be filed in person or by mail. -rI t I F at MAY 2 6 2020
O�CJb � 1�. , at I Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. Bounty Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is - ,
located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Bobby R. & Neena F. Livermore
Taxing District Key number/legal description Record number Page number
Princeton 26-11-12-301-002.749-028 2-020 6.5--3 _Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applict the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$ 75,000 llYes ❑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
IZI Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _ 7
Old National Bank FIJI4 1 )
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) — S -"
Name of assignee or other owner or holder of mortgage MAY 2g 2020
Address of assignee(number and street,city,state,and ZIP code) n i ._
Does applicant own property in any If yes,what county? What Taxing District? GIBb +J t -detbl tic tieen•regE4S't d If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ®No current year? ®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
Signature of County Auditor 1Y vl ik c. County �s\�p� Date(mo day,y a �
ZA-
I/We certify under the penalty of perjury that the above and foregoing information is trt]ei and correct and that the applicant is reside t of Indiana and
F_ owner/contract buyer of the aforementioned property on date application is filed.
Sg Signature(owners`fi,ll name) ). �I Late(mo h-da;;�ysa-ry
:dL y~� i' ,J Ip� / Goy, f>'
Full resident dress of applicant(number and street,city,state,and ZIP code)
115 S. Broadview Circle, 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 MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Bobby R. & Neena F. Livermore II[y.: I tion'`ri
li-
Date filed( onth,day,year) Amount of indebtedness 'axing District
3 ZO2 $ 75,000 Princeton
Key numb /lega�description MAY 2 2020
26-11-12-301-002.749-02: ' 5-2Signature of C n Auditor/County'ecord Count Date(m nth,d ,year)
tni � -A ',, s 26 TO
GIBSON COUNTY AUDITOR