HomeMy WebLinkAboutMortgage_Gregory ems" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
/ _n_x FOR DEDUCTION FROM ASSESSED VALUATION
is State Forth 43709(R13/10-15) ��""�� �I''1 T�
.• Prescribed by Department of Local Government Finance J' J Y J d 1\
INSTRUCTIONS: mil®a'rlF. J®L!N
To be filed in person or by mail. Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 7
•
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is N 15 (Cs
ounty Author
located on or before January 5 of the immediately succeeding calendar year ❑ ount Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the co
where the property is located during the twreNe(12)months before March 31 of each year the deduction is
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AU n I Tn R
Applicant(owner or contract buyer-see restrictions on reverse side)
Sonny Gregory
Taxing District Key number I legal description Record number Page number
Barton 26-20-14-100-001.717-001 ao kL- a31`l
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anent year assessment date,current year date of application legal or equitable owner?
$50,000.00 ❑ 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 the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fairfield National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes ill No current year? ❑Yes El No
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:
2D 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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.
Sip nature(owner's full name) Date(month,day,year)
X 6, –/S—/6
Full resident ad of applicant(narn . street.city,state,and ZIP code)
6609 S SR 57, Oakland City, IN 47660
Person authorized by duly executed Power of Attomey 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 years and a fine not to exceed 510,000.