HomeMy WebLinkAboutMortgage_Pinkston ,, a. • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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�" a FOR DEDUCTION FROM ASSESSED VALUATIONiM"t
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�s s�>' , e,. State Form 43709(R14/1-20) .�,3i) 0 �� 2021
o��/J Prescribed by Department of Local Government Finance File Mark
Me
INSTRUCTIONS:
To be filled in person or by mail. Fo fed with:
Filing Dates: Form must be completed and dated in the calendar year for which the deduction is sought.
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 ae first due County Auditor
and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Thomas L. Pinkston and Kimberly M. Pinkston
Ta ll IIi ri Key number/legal description 26-12-03-400-000.299-027/ Record number Page number
Assessed value o real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a plicant the sole
assessment date,current year assessment date,current year date of application leg I equitable owner?
$115,000.00 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 a property in question: Annually Assessed
Real erty ❑Annually Assessed
1:4 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Springs Valley Bank&Trust Company
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) /-F� ;
1500 Main Street,Jasper, IN 47546 O C .1
Name of assignee or other own:r• older o ortgag (�y �` ,9 0e
g ✓ / ' g /lC.r ���-�V sOti 00,
,
Address of assignee(number an;s t,city,state,and ZIP code) /������ t/NT`
Y .
Does applicant own property in any If yes,what county? What Taxing District? Has this deducion been requedtp r If yes,state amount of
other county on property for 'Q deduction
in Indiana? 0 Yes 0 No current year? es 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contr 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)tha is e 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)
� l 0, .mac,.-11. , f k.SOr� c4 149 I
II W&-certify under the penalty of perjury that the above an oregoing 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.
Signature(owner's full na e) Date(mThJo '
h,flay,year)
X `IT& 1COt.)21, -
Full resident address of applicant(number and street,city,state,and ZIP code)
759 N 350 E, 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.