HomeMy WebLinkAboutMortgage_Miller (32) r. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` FOR DEDUCTION FROM ASSESSED VALUATION
`'J- = State Form 43709(R14/1-20) Gibson 2020
�` '. Prescribed by Department of Local Government Finance - _
File Mark
INSTRUCTIONS: To be filed in person or by mall.
Form flied with:
Filing Date: Fonn must be completed and dated In the calendar year for which the deduction is sought. ® County 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 am first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Phi{Ip W/Nancy J Miller 913-544-42040
Taxing District Key number/legal description Record number Page number
.Retake- 07-7-- 26-05-30-400-001.334-027 2018-00004.2Ge- y vo 0
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?
$15,837 $75,000 ®Yes 0 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
I Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
ETFCU Fit/Pli -1. )3Address of mortgagee or contract seller(number and street city,state,and ZiP code)
Name of assignee or other owner or holder of mortgage A U G Z 7 G i3 J
Address of assignee(number end steel,city,state,end ZIP code) .
Lf4iX7 _
Does applicant own property in any If yes,what county? Mat Taxing District? Has this deduction bFehlicbibriltia 0if estate amou t of deduction
Other county
®Yes ❑No Gibson Patoka °unman=,?r Dives ®No
A person is not entitled to this deduction unless the person has a balance on the persons 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
Sign of CountyAuditor Corn Date(month,day,year)
�+g /� ty
L PAiu 1 I �,ur-t . �� Sr�,'i c--09-Lo 2 63
<yl We certify unker ftte penalty of perjury t the above and foregoing Information is true and correct and that the applicant•Is a resident of Indiana and
owner 1 contracter of the aforementioned property on date application is flied.
Signs (o _er's�laetne)� �� iDete(mQntt,:day,year)
U8; Z ', Zoza
II resident ad of applicant nu ber end street,cliy,ate end ZIP code)
2682 N. Miler Reed Lane, 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. ill'
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RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT I T S
Name of applicant of
PPI Name mortgagee or contract se r
Phillip W/Nancy J Miller r ETFCU I cOti0
IA
Date filed(month,day,year) Amount of Indebtedness Taxing DiseiV 0
$15,837 • Patoka
Key number!legal description -41
26-05-30-400-001.334-027 °'
Signature of Co ty Auditor/County R er County S (,rhonth,day year)
At ,l Gibson GO cl day
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