HomeMy WebLinkAboutMortgage_Johnson (22) 40 i�e*s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
�/''i
y�:;_.. FOR DEDUCTION FROM ASSESSED VALUATION
l'<.7.Te.,`1 State Form 43709(R13/10-15) Gibson Princeton 2020
^ 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 .•w7 4 .4.e the property is ■❑ County Auditor
located on or before January 5 of the immediately succeeding calenc r ar. 5 ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Propert :-d • t r e th th-n • ' -.editor of the county
where the property is located during the twelve(12)months bet..I(--• a o 'e ear the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) 6 2��L�
Donald/Patricia Johnson - SUN �'
Taxing District Key number/legal description Record number Page number
Princeton 26-12-18-300-001.366-028 ,,e``nn1,�ag 202° 204-1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of e`/, ctiffdeebt-.ness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year 4tg�T, }A ion legal or equitable owner?
05G 52,000 El 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 /1 , ° — 0
7 /
Old National Bank V •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Drawer NO
Name of assignee or other owner or holder of mortgage
CardNO.
,
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 deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? El Yes ❑� No current year? ❑Yes ill 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(month,day,year)
aSh aS t•wt Gibson 06/26/2020
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforem tioned property on date application is filed.
XS�Kesident
ure wnef name) Date(month,day,year)
i 06/26/2020
address o applica ( mb r and street,city,state,and ZIP code)7 Outer S. Main, nceton, 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.