HomeMy WebLinkAboutMortgage_Martin (38) eR*•,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship Year
�� % , FOR DEDUCTION FROM ASSESSED int.. :7-. lily State Form 43709(R14/1-20) f Gibson Princeton 2020
"�.
re�a Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. AUG 2 8 2020
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. Z County Auditor
Must be filed or postmarked with the County Auditor or Coun ecorder•f tie/-• my where the property is
located on or before January 5 of the calendar year in whic .h l f ••='jj ,' are first.due and payable. • ❑ County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Charles & Mary Lou (Michael) Martin--Lives There
Taxing District Key number/legal description Record number Page number
Princeton 26-12-18-301-001.732-028 2016 3897
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?
$ 68,000 IZIYes ❑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
IZI Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
5/3 Bank ai.1 F /2/4,,(efr/ 4 0a.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
-i4! R
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
!/ � � ' t ��
Does applicant own property in any If yes,what county? What Taxing District' /� 11� feduction
other county
in Indiana? ❑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
Sign re of County Auditor County Date month da ear)
A. t ), • Gibson - "ate, ,0
I/We certify under the pens ty of perjury that th above et,d foregoing information is true and correct and that the applicant is a resident of Indiana and •
owner/contract buyer of the aforementioned pr perty on date application is filed.
Signature(owner ull na ) Date(month,day,year)
��
t3 J `� ' Q Q� Q -,On
.1. .
Full resident address of applicant(number and street,city,state,and ZIP code)
425 Blaine Avenue, 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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTED S
Name of applicant Name of mortgagee or contract seller
Charles & Mary Lou (Michael) Martin--Lives There 5/3 Bank El)
Date filed(month,day,year) Amount of indebtedness Taxing District AUG 2
8/28/2020 $ 68,000 Princeton 8?020
Key number/legal description
26-12-18-301-001.732-u 8 Gf8"SoA6� :-.41 J► ear)
Sign r of County Auditor/County'Fortier County
Gibson -)0a/: )/2020
6-Ai of