HomeMy WebLinkAboutMortgage_Page (3) l�'E RATS STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
w Year
FOR DEDUCTION FROM ASSESSED VALUATION
4,- Gibson 2021
... / State Form 43709(R14 f 1-20) 0 2 8
k° --1, Prescribed by Department of Local Government Finance
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File Mark
INSTRUCTIONS: To be filed in person or by mail Si mpl i fi l e/Patti/away T 2/12/2021
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. El 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. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jacob Page
Taxing District Key number/legal description Record num bar Page number
Princeton 26-12-07-404-002.470-028 aQ 6
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?
cv7 Oc' 0Yes ❑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 property in question:Annually Assessed
®Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Bank of England FILED
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5 Statehouse Plaza, #500, Little Rock, AR 72201 Feb 12 2021
Name of assignee or other owner or holder of mortgage W Ylrifs!%JPQ3
Address of assignee(number and street,city,state,and ZIP code) GIBBON COUNTY AUDITOR CB
Does 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
in Indiana? ❑Yes ®No on rproperty
for
curreentt yea for
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
CB t�i s�yy
Signature of County Auditor %f''!s6/LIdG���(/f�i J1Q� County Gson Date�(mpptlr,�lay„ylai)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicantll isll 1a/ressiddent of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Situ owner's full name) Date(month,day,year)
02/10/2021
Fuluresident dress of applicant(number and street,city,state,and ZIP code)
507 S Stout 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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Jacob Page Bank of England
Date filed(month,day,year) Amount of indebtedness istrict
2/12/2021 Slog FILeton
Key number/legal description /
26-12-07-404-002.470-028r Feb 12 2021
Signature of County Auditor/County R rddf6 County /fdd a fliaadte(month,day,year)
r
j�a G Son f;IRSf1N CfhINTY Al1fITf)R CR 2/12/2021