HomeMy WebLinkAboutMortgage_Masters (2) ,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i`( FOR DEDUCTION FROM ASSESSED VALUATION
l State Form 43709(R13/10-15) ``,-.� a `� ?ADZ)
�,� " Prescribed by Department of Local Go ent Finance RECEIVED JV G_ [�`�
INSTRUCTIONS: C
r— File Mark
To be filed in person or by mail. `� td�Lr i
JAN 0 3 2022 F. i :.with:
Filing Dates: 1) Real Property:Must be completed and date t the calendar year for which the deduction is sought.
Must be filed or postmarked with the Coun editor or County Recorder of the county where the property is ri County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property: County Recorder
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. I
Applicant(owner or contract buyer-see restrictions on reverse side)
Masters,Timothy
Taxing District Key number/legal description rd nytrtber Pag�'ttymf '
Princeton 26-12-07-303-004.176-028/RICHLAND FOREST 1 CO_.t t rU_ (V_
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 acwwcsment date,current year date of application legal or equitable owner?
98300.00 122248.00 147.474.00 Y Yes ID No
If no,what is his I 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
TILED x Real Property El Annually
Home(IC 6-1.1-7)lellyyAssessed
Mobile
Name of mortgagee or contract seller
United Wholesale Mortgage
Address of mortgagee or contract seller(number and street.city,state.and ZIP code) JAN 0 5 2022
SRS South Boulevard Fact.Pontiac.MI 4R341-3163
Name of assignee or other owner or holder of mortgage
y��...
//?chi a, J /4:' + .,. /
Address of assignee(number and street.city state,and ZIP code) GIBSON COUNTY AUDITOR
Does applicant own proper • any If yes,what county? What Taxing District? Has this deducti n requested If yes,state amount of deduction
other county `�(�,1\
in Indiana cu current year?
ear
El No Yes 0 No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage o con ct 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 offi e)tha 's 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( nth, y.year
I/We certify under the penalty of perjury that the above and foregoing information is ru and correct and that the applica is a sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
ture(owner's full name y Date(month,day.year)
14/
Full resident address of appli nt(n ber and street.city.state.and ZIP code)
506 W Monroe 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 veers and a fine Wont fn a1rraa.1 Tin non