HomeMy WebLinkAboutMortgage_Dial ,fr », STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
> FOR DEDUCTION FROM ASSESSED VALUATION
Si a State Form 43709(R14/1-20) Gibson Princeton 2020
y gem%' Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 10 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 are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Julie C. Dial
Taxing District Key number/legal description Record number Page number
Princeton 26-12-18-202-003.402-028 2020 yy aS
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?
$ 90,000 (, 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 applicant,indicate below: Is the property in quesLtion:Annually Assessed
®Real Property ['Annually Assessed
F1Eire(IC 6-1.1-7)
Name of mortgagee or contract seller T
Mortgage Masters
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
OCT O 1 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUDI R
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
I 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
Signs e f aunty Auditor ` ' County Date(month,day,year)
Tom- !. / . Gibson /0- /- 2-0 "Zc'�
II e certify under the Ity of perjury t e above and foregoing information is true and correct and that the applicant is a resident of Indiana and
er/contract buyer of the aforemention operty on date application is filed.
Signature(owner's full name) .
vs_,� C,11C;S� c�
1 Date(month,day,year)
i
Full rent address of applicant(number and street,city,state,and ZIP code)
1018 S. Stormont St., 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.
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