HomeMy WebLinkAboutMortgage_Pulte 1 � STATEMENT OF MORTGAGE OR CONTRACT INDE rEDN� SS County Township Year
°'' , FOR DEDUCTION FROM ASSESSED VALUATION
3\ r' -A State Form 43709(R13/10-15) Gibson Fort Branch 2020
."+a s;-', Prescribed by Department of Local Government Finance RECEIVED
File Mark
INSTRUCTIONS: � � 1 AN21 2019 Form filed with:
To be filed in person or by mail.
Filing Dates:1)Real Property:Must be 6pleted and dated in the calendar year for which the deduction is sought. KCounty Auditor
Must be filed orpostm. ed with the County Auditor or County Recorder of the county where the 0 County Recorder
property is located on or before January 5 of the immediately succeeding calendar year.
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)
Sylvia M. Pulte ,
Taxing District Key number/legal description Record 2urpber P r
Fort Branch 26-19-18-303-000.263-026 71`� !'�) 3
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 le I or equitable owner?
119,100.00 116,400.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with om
If name on record is different than that of applicant,indicate below: Is a propertyD in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6 1.1 7)
Name ofy mortgagee or contract seller
Royal United Mortgage Fit
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4670 Haven Pointe Blvd., Indianapolis, IN 46250 AUG 212020 .
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 a 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? IllYes o current year? ❑Yes 0 No
A person is not entitled to is 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, ay,year)
erss
al
I/We certify under the pen:ty of perjury that the above and foregoing information is ru and correct and that the applicant is a sider 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)
08/14/20
Full residen dress of applicant(number and street,city,state,and ZIP code)
100 S Church St, Fort Branch, IN, 47648
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. 4.57211