HomeMy WebLinkAboutMortgage_Bruce (12) .,..E..4 STATEMENT OF MORTGAGE OR CO 'r\4? IN E B r?NESS
a -a •
j County Township Year
FOR DEDUCTION FROM ASSESSED .` I• • 4
''K.,` i'= 2020
t. ,. ,��� State Form 43709(R13/10-15) Gibson Patoka Township. v.
,,16 Prescribed by Department of Local Government Finance
AUG 11 2020 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 ca/en year fo whi e-ceduction is sought.
Must be filed or postmarked with the County Auditor or the county where the property is ■❑ County Auditor
located on or before January 5 of the immediateix qr 4 I f"y& i kii-p p ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as eal rope y: us file with the o nty 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)
Rick& Mary Bruce
Taxing District Key number/legal description Record number Page number
Patoka Township 26-12-10-400-003.371-027 2020 2'8 2 6
Assessed value of real property as of 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?
$150,000 ❑■ 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 applican in7i ate w: t• Is the property in question:Annually Assessed
AaN-
���' 0 Real Property ❑ Annually Assessed
`� / --- - - _ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller G� �Ks0 ----_ -- _ __
Old National Bank Q. 4-
Drawer
Address of mortgagee or contract seller(number and street,city,s ate, lode)
�c,°J Di'a�vci' NO... .Name of assignee or other owner or holder of mortgage O
Address of assignee(number and street,city,state,and Zlde) Card NO•
Does applicant own property in any If yes,what county? What Taxing District? ••1 � (/ ••• of deduction
other county v "`
in Indiana? ❑Yes ❑l No '
,-
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebteon .__ din 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)
.AA•-, 1,,, Gibson 8/11/2020
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 aforementioned property on date application is filed.
Signature( wner's full name Date(month,day,year)
Fu,L� (*c � 08/11/2020
Full resid t a a ress of ap lica (number ands et,city,state,and ZIP code)
3280 E 50 e., Pri ceton, 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 foroeriury can include imprisonment Ito to two and a half years and a fine not to exceed$10.000.