HomeMy WebLinkAboutMortgage_Robbins (5) STATEMENT OF MORr4AOE OR
CONTRACT INDEBTEDNESS County Township Year
= ' FOR DEDUCTION FROM ASSESSE®VALUATION
Gibson Princeton 2020
, State Form 43709(R1411-20) FUe Mark
=✓ Prescribed by Department of Local Government Finance Form Ned with:
mail.. ® County Auditor
INSTRUCTIONS: To be filed in person or byfor which the deduction is where the property is0 Cow Recorder
Date! FOrRr must be completed ed wit with the c d In 0 my Auditor ondar year
r County Recorder of the county sought b1e
'i i�iQlocated
Ned orpcatln�r� taxes are first due and pays
on or befell!January 9 of the opiendar year In which the Property
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) Retold number Pape number
Andrew&Beth Robbins 2020 ��y,-1�
Taxing District• Key number I legal description 1leant the sole
Princeton 26-11-12-103-000.047-028legal or equitable awned
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage
to of apPIC tiosfta Indebtedness unpaid as o1 Is the eP®Yesob ❑Lf?
assessment date,current year assessment date,current year $
100'400
If nit,what is his/her axed share of Interest? If owned With
someone other than spouse,indicate with whom
Is the property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: Annuall A55eSSf3d
�Rt~al Property ❑Mobile Nortte pC 6-1.1•7)
IiName of mortgagee or contract seller
Heritage Federal Credit Union
Address of mortgagee or contract seller(number and street city,stele,and ZiP code)
OCT 0i ..).0
Name of assignee or other owner or holder of mortgage
Address of assignee(numberendstreet,city,state,andZIPcode)
ct-^�'ON CCuy I'Y AUDITOR
Does countyapplicantown property in any It yes,what county? What Taxing District? Has this deduction been requested If yes,stele amount of deduction
other county
in Indiana? ❑Yes ®No on property for
Yes
No
rent
A person Is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtednesse that is recorded In the county
recorder's office(Including any home equity line of credit that is reeorcied in the county recorder's office)that is the balls for the deduction.
Deduction approved In the amount of: COUNTY AUDITOR
20 20
20 20
20
i _ 20 20
WeI/ _.,_+.� ! t County Date(month,day,year}
,iffy under the penalty of perjury,that the ab• ` Gibson 1f _
ro a and a Ding Information Is true and correct and that the apptiaa a'resident o di�a and'
owner/contract buyer of the aforementioned
Signature(owner ame) /J� p 1�rtY on date appt(cati0n Is flied.
, .r!� Date(mon ,day, ear)
Full resident address of applicant(n "bar and street city,state,end ZIP Bode
205 N. 5th Avenue, Princeton, 1N 47670 .� J 5 Z
Person authorized by duly executed Power of Attorney or by IC 6.1.1-12-0.7
Address of authorized person (number and street,city, Date(month,day,year)
ty state,and ZIP code)
The penalties for perjury can include imprisonme rrt Up to two an
d a helfyears and a fine not to exceed
Name of applicant
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT- -
ndrew&Beth A. RobbinsINDEBTEDNESS
Date foe. month day, Name of mortgagee or mobs A
y year) Herita e F aB'tar
1 • • _ . Amount of indebtedness 9 Fed Credit Union
Key number/legal deserip4on -
ey number/
-12- - $100,WI o District
103-000,047-028 t . �1 6 ceton
Sig t turaof County Audrtor/Court,• '— s
!1►__ _( County' ` g020 Date onlh, •a
u -`—,_ Gibson, 1'.® L
t♦ 1' — Y year
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