HomeMy WebLinkAboutMortgage_Manuel Me sM�yO. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'F;•,w FOR DEDUCTION FROM ASSESSED VALUATION
,u State Form 43709(R14/1-20) Gibson 028 2020
a ' Prescribed by Department of Local Government Finance
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File Mark
INSTRUCTIONS: To be tiled in person or by mail.
Broadway Ti tl a/Si mD1 i f i l efi 11/02/2020 Form filed with:
Filing Date: Form must be completed and dated in the calen ar year for which the de auction rs soug t. 0 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)
George E. Manuel and James S. Dow
Princeton 26-11-13-204-001.630-028 2-0 ZO 49'gs
Assessed value of real property as of Mortgage!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?
$62,000.00 [, 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 question:Annually Assessed
®Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Clay County State Bank FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
111 N Church St., P.O. Box 248, Louisville, KY 62858-0248 Nov 02 2020
Name of assignee or other owner or holder of mortgage A^
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? XI 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)CB
JT+��^• G' son 11/02/2020
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 full name)t , Date(month,day,year)
10/30/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
702 Makemson Ave., Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Dale(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 S10,000.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller FILED
George E. Manuel and James S. Dow Clay County State Bank
Date fi led(month,day, eaar) Amount of indebtedness Taxing District Nov 02 2020
11/02/202 $62,000.00 Princeton
Key number/legal description
26-11-13-204-001.630-028 ��`a�- ', O GIBSON COUNTY AUDITOR CB
Signature of County Auditor I County Recorder County Date(month,day,year)
CB G'son 11/02/2020