HomeMy WebLinkAboutMortgage_Burgan - STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
% FOR DEDUCTION FROM ASSESSED VALUATION
a State Form 43709(R11 6-09) RECEIVED Gibson Princeton 2022
*y M1_ -," Prescribed by Department of Local Government Finance
Pew _
`� a �� , FEB 1 5 2022 File Mark
INSTRUCTIONS: ' '
To be filed in person or by mail.
Filing Dates: 1.) Real Property: Must be completed and dated in the calendar year for which the deduction is sought. Form filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located r�r
on or before January 5 of the immediately succeeding calendar year. Q County Auditor
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of the Recorder
county where the property is located during the twelve(12)months before March 31 of each year the County
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer—see restrictions on reverse side) p �7
* Seth D.Burgan and Britta L.Burgan ("/ --`f) ,c .-"� - /� q O _0„�-�+
Taxing Dist t2 Key number/legal description Recordt hurter Page number
*WARNOCK SUB DIV 3 PT r .77
Assessed value of real property as of Mortgage/Contract indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
* $0.00 *$0.00 *$103,790.00 El 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 the property in question: Annually Assessed
❑ Real Property ❑ Annually Assessed
■■T^��/ Mobile Home(IC 6-1.1-7)
Name rtf magrt Masers contract ,Inc.er F I L �I�J
* Mortgage Masters of Indiana,I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
* 501 N Cross Pointe Blvd, Evansville,IN 47715
Name of assignee or other owner or holder of mortgage FEB 1 5 2022
Address of assignee(number and street, city,state,and ZIP code) c��
/// ."./°rant' i:S:. ,✓, 1.::..,..✓
Does applicant own property in any other In yes,what county? What Taxin(Brati PCOUN sutia49 ation been e uested on property
county in Indiana? for current year?
❑ Yes X No Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County it �� County t, Date`�'('rr'Jray, ar)
certifyunder the enalt of er'u that t e above and foregoing information is tru3...S"Qk
correct and that the applicant Fslla r identde of Indiana and
I I We penalty perjury ry
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) �" .--- �,/ Date(month,day,year)
���i`��" j a.------ 02/07/2022
Full resident address of applicant(number and street,city, state,and ZIP code)
* 703 N.Blain St,Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person(number and street, city, state, and ZIP code)