HomeMy WebLinkAboutMortgage_Schlottman (3) -' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year l
d ` \ FOR DEDUCTION FROM ASSESSED VALUATION I l I
i, State Form 43709(R14/1-20) ) S�� 2022
*O j sem Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS:
To be filled in person or by mail. For 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. 0 County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Tracy Lynne Schlottman
Taxing District Key number/legal description 26-11-12-203-000.672-028/205 9th St. Record number Page number
0 Princeton, Indiana 47670
26-11-12-203-000.672-028
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is t plicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
$80,808.00 0 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 tie.", perty in question: Annually Assessed
Real Property 0 Annually Assessed
/L Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Mortgage Masters of Indiana, Inc.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) --40
501 N. Cross Pointe Blvd., Evansville, IN 47715 414R j 62
Name of assignee or other owner or holder of mortgage 022
GfB.c
Address of assignee(number and street,city,state,and ZIP code) ON
UN..
A
Does applicant own property in any yes,what county? What Taxing District? Has this deduction beeIV-Ilia., d f yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes ❑ No current year? 0 Yes 0 o
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//�� Counttyv Date(month,day,year)
�-[� lit rip Q LL_ V �1 4 `-. �J�, ' : — c'Z 2
1 • 'S— z
I/We certify under the penalty of perjury that th above and foregoing information is true and correct and that the applicant is a resident of Indiana
and wner/contract bu er of the aforem tioned property on date application is filed.
Sign re(owner's full na y Date(moo ,da year)`
residen add ss of appli nt(number and stre ci state,and ZIP code)
205 9th St., ceton, 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 vearc and a fine not to exceed$10,000.