HomeMy WebLinkAboutMortgage_Sablone • % STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7f �� FOR DEDUCTION FROM ASSESSED VALUATION
�l �iY .:.Vx State Form 43709(R14 I 1-20) GIBSON Princeton 2020
,eie=•, 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. ® 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
Record number Page number
Princeton 26-12-06-104-000.605-028 2DZD-4' 'D
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
X assessment date,current year assessment date,current year date of applicationi legal or equitable owner?
$ 1Loq,1 ASS l 1Yes ❑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
®Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
X--Mo F&edam 1,14L4 --�
Address of mortgagee or contract seller(number and street,city, e,and ZIP code) FName of assignee or other owner or hcl''---^f_m^t+, c'
0 Di'o -- 010 OCT 262020
Address of assignee(number and stre ' Di-av'e1- NO
Ll i t
Does applicant own property in ny this deduction been reques r r�ou of deduction
v other county ❑ property for
in Indiana? Yes No Card NO entyear? ❑`a41311.1 cCOUNTY AUDITOR
•
A person is not entitled to this ded ,rtgage or contract indebtedness that is recorded in the county
recorder's office(including any ho, der's office)that is the basis for the deduction.
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sign r of County Audit r County Date(month,day,year)
AAJ, to GIBSON 10/26/2020
We certify un e the penalty of 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 afore ntioned property on date application is filed.
Signature o rs full na �^ Date(month,day,year')
., � ,/ �� 10/26/2020
Full reside dresso plicant number and street,city,state,and ZIP code)
1208 N Main, 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)
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