HomeMy WebLinkAboutMortgage_Ross (8) 4HE R*, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
I��;� _ Year
FOR DEDUCTION FROM ASSESSED VALUATION
f `,- State Form 43709(R14/1-20)
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.
J L s,
Applicant(owner or contract buyer-see restrictions on reverse side)
Ross, Billy Joe II A'
Taxing District Key number/legal description JAN i 2021 Record number Page number
022 26-18-07-101-000.461-022 O2- L
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as oo).iiortgage/ ct indebtedness unpaid Is the applicant the sole
assessment date,current year assessment date,current year �'((hate of.app' tion legal or equitable owner?
GIBSOIV ,�7 v i!- O� 0 1ZYes ❑No
If no,what is his/her exact share of interest? If owned with some ne other th n sp• se,indicate with whom
If name on record is ' r ha hat of plicant,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
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 ❑No current year? ®Yes ❑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:
20 20 20 20 20 20 20
ASignature of u u ito County Date(month,day,year)�Q� 1/11/2021
I/We certify under the penalty of perjury he above and foregoing information is true a d orrect and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Sign owh is ull name) Date(month,day,year)
1/11/2021
Full resident address of plica .(number and street,city,state,and ZIP code)
406 E Mon me , PO Box 704, O'ville, IN 47665
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 nanaltias for neriury can include imprisonment up to two and a half years and a fine not to exceed$10,000.