HomeMy WebLinkAboutMortgage_Arbuckle °'"" STATEMENT OF MORTGAGE OR CONTRACT-INDEBTES County Towns ip Year
s FOR DEDUCTION FROM ASSESSED VALUATION dZ
Ak400.,...) State Form 43709(R14/1-20) Gibson 2020
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: Form filed with:
To be filed in person or by mail.
Filing Dates:1)Real Property: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 County Recorder
property is located on or before January 5 of the immediately succeeding calendar year. - -
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(owner or contract buyer—see restrictions on reverse side)
Matthew D. buckle ,
2 Taxing District g Key number/legal description Record� 'nuumber Pa n�pbQr
-Patoka— 26-11-12-104-002.664-028 !%v (Jttt�lllhhhl—�` ►v^
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant a sole
assessment date,current year assessment date,current year date of application le I or equitable owner?
113,030.00 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with w om
If name on record is different than that of applicant,indicate below: -1 I, p*,question:Annually Assessed
l P P .•-t, 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, DEC 2 2 2020
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
501 N. Cross Pointe Blvd, Evansville, IN 47715
Name of assignee or other owner or holder of mortgage
GIBSON COUNTY AUDITOR
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in ny If yes,what county? What Taxing District? Has this deduct' n be requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes No current year? Yes ❑No
A person is not entitled t this deduction unless the person has a balance on the person's mortgage or nt ct indebtedness that is recorded in the county
recorder's office(inclu ng any home equity line of credit that is recorded in the county recorder's office).that r the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 � 20 20 20 20 20
� I
Signature of County Audi• County l Date( onth,da ar)e
MIL
I,We certify under the penalty of perjury h ate and foregoing informationALso
ue and correct and that the appiica t is a re ident of Indiana and
owner/contract buyer of the aforementioned property on ate application is filed.
pature is full Datro j(1,day,year)Ful esiddress of applicant ber an street,city,state, ZI code) l11 �1V'�V l%v
�'
110 N 1st Ave, 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. 46943