HomeMy WebLinkAboutMortgage_Couts 0E *a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
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a `l:./. State Form 43709(R13/10-15) Gibson Princeton 2020
'° „—e-- Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is • County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
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 wner or contract buyer-see restrictions on reverse side)
Mich el A. Couts
Taxing strict Key number/legal description Record number Page number
Princeton 26-12-07-304-001.219-028 2020 4 5 4--
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?
$ 85,065 ❑■ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
t
If name on record is different than that of applicant,indicate below: fi ,• p rty in question:Annually Assessed
__f `❑ I ope ❑ Annually Assessed
1.1 Mobile Home(IC 6- -7)
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Name of mortgagee or contract seller �y / 4�i
•
Quicken Loans, LLC < D G ( D� / S S+�e,p
Address of mortgagee or contract selle d
Name of assignee or other owner or he rr�)u i L It Zr� s'ON •
Address of assignee(number and stre r,6 oin d.� /I le5� - COY
Does applicant own property in any ( !eduction been requested If ye"late amount of deduction
other county -.ty for
in Indiana? ❑Yes ❑� No I I current year? ❑i 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
Signature of County Auditor County Date(month,day,year)
1- L / Gibson 09/03/2020
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(o ers 11 name) Date(month,day,year)
‘0:7:1,,y______________
09/03/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
414 S. Hart 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)
Tha nanaltiec for nerirw can include imnricnnment fin to twn and a half vears and a fine not to exceed. 10.000_