HomeMy WebLinkAboutMortgage_Campbell (13) E", y STATEMENT OF MORTGAGE OR CONTRACT INDEBT�ED�SS County ioawnsh Year
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r: :r FOR DEDUCTION FROM ASSESSED VALUATION _ Gibson --Patotea— 2021
1 `'fi ' State Form 43709(R14/1-20)
:N Prescribed by Department of Loune
cal Government Finance REC EtVED
FEB 10 2021 File Mark
INSTRUCTIONS: c�� � 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)
Jackie Campbell ,
Taxing District 2S Key number/legal description Rec rd number Page number
26-12-17-101-000.820-028
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican the sole
assessment date,current year assessment date,current year date of application I al or equitable owner?
78,800.00 126,262.00 es 0 No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with om
If name on record is different than that of applicant,indicate below: Is a property in question:Annually Assessed
eal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED
Bank of England, ISAOA/ATIMA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
P.O. Box 3490, Little Rock, AR 72203 FEB 10 2021
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) h,,,,A ,e a. JA-u..„4,A4ra)
GIBSON COUNTY AUDITOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio be n requested If yes,state amount of deduction
other county on property for •
in Indiana? ❑Yes o current year? Yes D No
A person is not entitled t this deduction unless the person has a balance on the person's mortgage or n act indebtedness that is recorded in the county
recorder's office(including any home equity fine of credit that is recorded in the county recorder's office th is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Aud' r �^ County \ Date(moot day, ear) .
�o() VU. 21
I/We certify under the penalty of perjury that th b and foregoing information is t ee and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si ature(owner's full name) Date(month,day,year)
tt-Q01/29/21
Ful ent address number a street,city,state,and ZIP code)
10 S Adams St, 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. 47182