HomeMy WebLinkAboutMortgage_Ireland f Fr.,• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.' 1� FOR DEDUCTION FROM ASSESSED VALUATION
9 ��' State Form 43709(R14/1-20) Gibson Barton 2020
'4, /10—•? 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. 1 m County Auditor
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 are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ethan Wayne & Shadoe K. Ireland
Taxing District Key number/legal description Record number Page number
Barton 26-20-13-200-000.771-001 cDOa C) 3 t C)f7
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 assessment date,current year date of application legal or equitable owner?
$ 180,000 E1Yes ❑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
IZ1 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
LNB Community Bank ii
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Address of mortgagee or contract seller(number and street,city,state,and ZIP code) �Q
Name of assignee or other owner or holder of mortgage � -
9
FP 112020
Address of assignee(number and street,city,state,and ZIP code)
ti Does applicant own property in any If yes,what county? What Taxing District? Has this 't ,9g, , to amount of deduction . .
other county on property ®
for IN(
in Indiana? ❑Yes ®No current year? Yes
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness tiOffs 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
Sign ture of County Auditor County Date(month,day,year)
Yk � , Gibson CA (1 ' ��n
I/We certify under the penalty of perjury that thJbove di 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.
_ _ _
(Signaturew11 eQ c _ Date7month`day year)
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Full resident address of applicant(number and street,city,state,and ZIP code)
6778 S 1100 E, Oakland City, IN 47660
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
l
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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INIfT `SS
Name of applicant Name of mortgagee or con ct selie `"
Ethan W& Shadoe K Ireland LNB Comm -'IL1a
a '4
Date fil (month,day,year) Amount of indebtedness axing Diriel,
." — l— p'' 0) _ $ 180,000 Bart ‘
Key number/legal description"' C� ` ♦ ,_ OA
26-20-13-200-000.771-401 J ,�� pv
Sign re of County Auditor/Count corder Countyt-lk month,day,year)
Gibson o� - k`- �0a0 .
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