HomeMy WebLinkAboutMortgage_Cox (22) •I
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o STATEMENT OF MORTGAGE.OR CONTRACT INDEBTEDNESS County Township Year
i.;,; � FOR DEDUCTION FROM ASSESSED VALUATION
a ol. Stale Form 43709(R1411-20) Gibson Patoka Twnsp 2020
v)„,."� Prescribed by Department of Local Government Finance -
t File Mark
I, INSTRUCTIONS: To be filed In person or by mail. Form bled with:
'i Filing Date: Fomf must be completed and dated In the calendar year for which the deduction Is sought. m County Auditor
I. Must be filed or postmarked with the County Auditor or County Recorder of the county where the property Is
i located on or before January 5 of the calendar year In which the property taxes aro first due and payable. 0 County Recorder
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See reverse side for additional instructions and qualifications.
i Applicant(owner or contract buyer-see restrictions on reverse side)
., Rachael Cox
Taxing District Key number/legal description Record number Page number
Patoka Township 26-05-40-211-000.797-027
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid os of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sofa
assessment date,current year assessment date,current year date of application legal or equitable owner?
$214,000 ®Yes ❑No
k I1 no.what is his/her exact share of interest? If owned with someone other than spouse.Indicate with whom
t; It name on record is different than that of applicant.Indicate below: Is the property in question:Annually Assessed
4 ®Real Property ❑Annually Assessed
Mobile Home(IC 6-1,1-7)
�? Name of mortgagee or contract seller
a Freedom Mortgage pi-L
Address of mortgagee or contract seller(number and street,city,slate,and ZIP code) DE-
A Name of assignee or other owner or holder of mortgage I.vZ;!
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' Address of assignee(number end street,city,stale,and VP code) Gies . JJ-_�rs �'��--! i -
Does applicant own property in any II yes,what county? 'Wnal Taxing District? OHas this ddedudtirin 4oityested If yes,state amount of deduction .. .
other county on property for UU
in Indiana? ❑Yes ®No current year? ®Yes
s 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.
1 COUNTY AUDITOR .,',..,
Deduction approved In the amount of:
20 20 20 20 20 20 20
it SI azure of County Auditor County Date(month,de,year)
nr r1—'1 Gibson la—Q. -a�O .
I/We certi under t /pen Ih'o erjury that 1 e albove an regoing Information is true and correct and that the applicant is a resident of Indiana and
owner/ tract buy/of 2 ff I d roperty on date application Is filed.
Signature( is lull na e) Date(month.day,year)
r N, 10—all)
`r Full resident address of applicant(number and street.city,state.and ZIP code) ,
I 171 W 225 N, Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12.0.7 Date(month,day,year)
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.I Address of authorized person(number and street,city,slate,and ZIP code)
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t The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
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RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
? Name of applicant Name of mortgagee or contract seller
Rachael Cox Freedom Mortgage
Date tied(month,day year) Amount of Indebtedness Taxing District
t' "cR, 0. $214,000 Patoka Township
Key number/legal description
i 26-05-40-211-000.797-027 i` T t
Signal e f CountyAuditor/County corder .+� ' .,ou 'w Date(month,day,year%
a .., lc , -fig, ac,a0.
DEC 28 ?V, 0
GIBS COUNTY AUDITC►P -