HomeMy WebLinkAboutMortgage_Bland (2) s.•..*.r.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION Gibson Princeton 2022
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State Form 43709(R14/1-20)
T.-0. Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. m County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is El County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due and payable.
Applicant(owner or contract buyer-see restrictions on reverse side)
Connie S Bland
Taxing District Key number/legal description Record number Page number
Princeton 26-12-07-402-002.771-028 2022 4976
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant
equitabl the e owner?sle
assessment date,current year assessment date,current year date of application g
$ 119,000 66Yes ❑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 ❑Mobile Annually
Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Spring Valley Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) TT ■T'
Name of assignee or other owner or holder of mortgage l ,T� f"'1 L
Address of assignee(number and street,city,state,and ZIP code) (n�1�`,, y�j--,/�/
What TaxingDistrict? Has this deduction been requd9ttd' 2 y1415,Zl ?.Zmount of deduction
Does applicant own property in any If yes,what county? on property for Yes ❑No $ 3,000
other county ❑Yes ®No current year?
in Indiana?
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nb e con th o in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)th '
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Cv ,-. _ty Date(month,day,year)
Signature of County Auditor /�I_1.�j/"� Gibson 12/20/2022
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.
Date(month,day,year)
Signature(owner's full name) lam7? 12/20/22
P.
Full resident address of applicant(numb ber a d street,city,state,and ZIP code)
310 S Stout St., Princeton, IN 47670 'Date(month,day,year)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7
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 years and a fine not to exceed$10,000.