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DER-"0. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
f N� s FOR DEDUCTION FROM ASSESSED VALUATION
2i .',:_ f),= State Form 43709(R14/1-20) Glbson Princeton 2020
, 3-V. 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. Z 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)
Robert& Rosemary Quinlin
Taxing District Key number/legal description Record number Page numbe
Princeton 26-12-17-101-000.607-028 co,c OIti4
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of s the applicant the sol
assessment date,current year assessment date,current year date of application legal or equitable owner?
$ 71,000 tlYes ill No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It narne 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 sellerPil:t
Old National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 1
46
I)
Name of assignee or other owner or holder of mortgage O(C y
Address of assignee(number and street,city,state,and ZIP code) &&
—2420
Does applicant own property in any If yes,what county? What Taxing District? O�Ha9tbf requested If yes,state amount of deduction
other county on prope )for
in Indiana? ❑Yes 0 No current year? es ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or-co ' debtedness 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 he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sign tune of County Auditor County Date(month,day,year)
Gibson I —c (J C
1/We certify under the penalty of perjury that the above and fo 'ng 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. _____ « _
j+g Sign re wn rs full ame)' i ' Date(month,day,year)
J C %�.t ru_m�24? ( 1,u nL--1- L —%I a‘:—` '
Full resident address of appli�t(number and street,city,state,and ZIP code)
911 S. Adams, 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 contr ct-s@Ile'
Robert C & Rosemary Quinlin Old Nr 1.111aLike, TiDate filed month,day,year) Amount of indebtednessAg5cing District
I .1 — 4D0 , $ 71,000 Princeton
Key number/legal description D -t , 1 20
26-12-17-101-000.607-028 l
Sign ure of County Auditor/County R order County Date(month,day,year)
`Q �� Gibson �,f°tcfi„�G ' �,�Clkk " I-- c -
GIas