HomeMy WebLinkAboutMortgage_McFall STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County ' Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
i• ';"f' State Form 43709(R14/1-20) Gibson Princeton 2021
°ads Prescribed by Department of Local Government Finance ,, -
(R rV File Mark
6dTRllCTIONS: wV�- I MAR 0 51021 Form filed with:
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To be filed in person or by mail.
Filing Dates:1)Real Property:Must be c;:r4Oieted and dated in the calendar year for which the deduction is sought. 11)( 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)
Shelby McFall
Taxing District Key number/legal description Record number Pagyumber
Princeton 26-12-07-303-001.539-028 2O Lk5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the a�cant e'sole
assessment date,current year assessment date,current year date of application lezel or equitable owner?
45,900.00 79,540.00 zgA Yes 0 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 e property in question:Annually Assessed
Real Property ❑Annually Assessed
ED Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
German American Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
711 Main Street, PO Box 360, Jasper, IN 47546 LIAR Ott°21
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) !/ .
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Does applicant own property in If yes,what county? What Taxing District? Has this deduction bee equested If yes,state amount of deduction
other county on property for AUDITOR
in Indiana? ❑Yes No current year?GIBB Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage contraN ctC 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 I D (mo h,day year)
I/We certify under the pena . _ •erjury that the above and foregoing information is tr e d correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
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Signature wne s ful ame) Date(month,day,year)
1 t, /„7nf 03/01/21 •
Full resident address o -..licant(number and street,city,state,and ZIP code)
603 W Pinkne' St, Princeton, IN, 47670-2357
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
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Address of authorized person(number and street,city,state,and ZIP code)
fnr',nth Iry can include imprisonment up to two and a half years and a fine nntto exceed$10,000. 47456