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HomeMy WebLinkAboutMortgage_Blackburn (7) e t n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 71.._:,.. .p ,j FOR DEDUCTION - �' rf'.';'Z � State Form 43709(R14/1-20) Gibson Princeton 2021 • -. Prescribed by Department �eie ^,^ INSTRUCTIONS: To be filed in person cU V—/1` File Mark Drawer NO Form filed with: Filing Date: Form must be completed / t. Must be filed or postmark L is ` sere the property is Z County Auditor located on or before Jam Card NO• - ue and payable. ❑ County Recorder See reverse side for additional instruction; Applicant(owner or contract buyer-see restrictions on reverse side) Mark & Debora Blackburn Taxing District Key number/legal description Record number Page number Princeton 26-12-08-203-001.972-028 �.03a.1 H Slo 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? $ 105,000 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,indicate below: Is the property in question:Annually Assessed ®Real Property ❑Annually Assessed pli-LEMobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Rocket Mortgage Address of mortgagee or contract seller(number and street,city,state,and ZIP code) F -12) Ee 21 • • Name of assignee or other owner or holder of mortgage � 202, G/es, Address of assignee(number and street,city,state,and ZIP code) ©Al Cp 0 U�ryAU Does applicant own property in any If yes,what county? What Taxing District? Has this deductio/ requested If yes,state amount of deduction other county on property for in Indiana? ❑Yes ®No 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) f \.L —k r Gibson 2/22/2021 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. (owners full name)Sig .tart ) Date(month,day,year) Ful sident address of applicant(number and street,city,state,and ZIP code) 302 Harding Avenue, 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)