HomeMy WebLinkAboutMortgage_Poling (3) ff-T �. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship Year
%� FOR DEDUCTION FROM ASSESSED VALUATIONS
�\ 1 );1 State Form 43709(R13/10-15) RECEIVED Gibson Patoka Town 2020
a•i'Lei®' ' Prescribed by Department of Local Government Finance
INSTRUCTIONS: SO uO,�„ �L l e JUL 142019 File Mark
To be filed in person or by mail. ' 1 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)
Brittany L. Poling .
Taxing District Key number/legal description R cord number Page number
Patoka Towns 26-11-13-202-002.086-027 o vt SOf15
Assessed value of real property as o Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
148,400 115,000 158,800 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
J e-t. :'s_e_rty .❑ Annually Assessed_ _ _
r F 1 4 I r Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller . . . -
First National Bank of Carmi
Address of mortgagee or contract seller(number and street city,state,and ZIP code) JUL S 4 2020
209 E. Main St. Carmi, IL 62821
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUDITOR
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? ❑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 20
•
Signature of County Auditor , , County 1 Date month day,year)
♦ tYce.) Soil -( - 2.y'20�
I/We certify under the penalty of perjury that t ove and foregoing information is e and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si natu owrter's full na e) 0� Date(month,day,year)
1It . 07-16-2020
F. II resi ent adds ap cant(number a.d street,city,state,and ZIP cads) -
668 W w =rk Ave 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 nenaltie.e fnr neriunr ran inr6,rle imnricnnment tin to twn and a half uearc and a fine not to ew-aod Tin nnn