HomeMy WebLinkAboutMortgage_Gibson (3) . -440. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e ":"A� . FOR DEDUCTION FROM ASSESSED VALUATION
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�;,,..k„,�J State Form 43709(R1411-20) Gibson
'%✓' Prescribed by Department of Local Government Finance
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File Mark
INSTRUCTIONS: To be filed in person or by mail. Si mpi i fi l e/Broadway T 10/29/2020 Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. m 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. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Shawn M. Gibson
Princeton 26-12-18-304-000.988-028 2020 Liq2$ -
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I 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?
$111,625.00 IZYes ❑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
Mortgage Masters of Indiana, Inc. FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 N. Cross Pointe Blvd., Evansville, IN 47715 Oct 29 2020
Name of assignee or other owner or holder of mortgage •,
Address of assignee(number and street,city,state,and ZIP code) GIBSON COUNTY AUDITOR CB
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
in Indiana? ❑Yes ®No current year? Xes 0 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 ure of County uditor County Date(month,day,year)
CB G' son 10/29/2020
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 I contract buyer of the aforementioned property on date application is filed.
Signatur owner's full name) /Date(month,day,year)
/1 +n--t ��tlJ�t �FY!�, 10/28/2020
Full resident address of applicant(number and street,city,state,and ZiP code)
2016 Boulevard PL, 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 INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller FILED
Shawn M. Gibson Mortgage Masters of Indiana,Inc.
Date filed(month,day.year) Amount of indebtedness Taxing District Oct 29 2020
10/29/2020 $111,625.00 Princeton 7�y��---
Key number/legal description
26-12-18-304-000.988-028 2)0 20 —1-IR 2- • GIBSON COUNTY AUDITOR CB
Sure of Coun y Aud'or/County Recorder County Date 16,2172020
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CB G'son V�LL /LL