HomeMy WebLinkAboutMortgage_Farms 0.E STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
1 (', State Form 43709(R14/1-20)so
Gibson Patoka Township 2020
� - . 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. IZ 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)
Big Creek Farms
Taxing District Key number!legal description Record number Page number
Patoka Township 26-11-15-202-004.784-027 a aQ (Q 1 Q 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/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?
$ 334,000 17j 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 in question:Annually Assessed
® a _re'2'- .y ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
First National Bank of Carmi s�
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)_ .. _ _ _, O`'e.9 .v �a
w y
Name of assignee or other owner or hi �f�s0 i e01�
Address of assignee(numb8er and sire \ - � `-V l„�.L\ �T
Does applicant own propert in any ' eduction been requested ifj ,)state amount of deduction
other county ._ 'y for OR
in Indiana? Yes No `'ar? Yes ❑No
A person is not entitled to this dec � i 'e or contract indebtedness that is recorded in the county
recorder's office(including any he ;•-office)that is the basis for the deduction.
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
k/nActJ Gibson 12/31/2020
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 of rementi ed property on date application is filed.
Signs re(owner's t ame) ` 'Date(month,day,year)
S 12/31/2020
./lull resid:/,dd of applica umber n reet,city,state,and ZIP code)
721 S. Cathy Dr, 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.