HomeMy WebLinkAboutMortgage_Osborne (4) 4E j B�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r:`t a FOR DEDUCTION FROM ASSESSED VALUATION
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'1 State Form 43709(R14/1-20) Gibson Princeton 2021
° i" . Prescribed by Department of Local Government Finance
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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. IZI 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)
Stanley Osborne
Taxing District Key number/legal description Record number Page number
Princeton 26-12-18-304-003.234-028 .. o D Q Sole
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?
$ 15,000 IZI 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,indicat low: Is the property in question:Annually Assessed
®Real Property ❑Annually Assessed
Mnhile_Hnme_(IC 6-1.1-7)
Name of mortgagee or contract seller t.1
Old National Bank
Address of mortgagee or contract seller 0/.90 er and stti�t city,sta an ZIP de) 2-60
/es Drawer NO
Name of assignee or other owner or holder�fi.iridrt9gage ,Q
Address of assignee(numberandstreet,city,state,�pdde) Card NO. L)q U
J-TeDoes 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 O on property for
in Indiana? Yes ®No 'Q current year? ®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)
C ro Gibson 1/6/2021
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.
ignatyfe)( nets full n e) 0 Dat (month,day,year)
Full resident address of ap ican number and street,city,state,and ZIP code)
1811 Blvd PI, 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 ro^APd$10,000.