HomeMy WebLinkAboutMortgage_Sloan (2) �f�`sure STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
aA,_: \,. FOR DEDUCTION FROM ASSESSED VALUATION
\ ;f .. . State Form 43709(R14 I 1-20) Gibson Barton 2021
°;16-6-"' Prescribed by Department of Local Government Finance
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= File Mark
INSTRUCTIONS: To be filed in person or by mail. lit.
Form filed with:
Filing Date: Form must be completed and dated in the ca id.r r,fir, " the deduction is sought. 121 County Auditor
Must be filed or postmarked with the County A .tor o ounty Reco of the county where the property is
located on or before January 5 of the calendar -r in which t pro` taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications. 0 '
Applicant(owner or contract buyer-see restrictions on reverse side) /) 0((4filOR
Michael L & Shannon E Sloan a�Co��N� (
Taxing District Key number/legal description "/ '"SIN L- Re d number P e umber
Barton 26-20-05-400-001.883-c.�� ��2N0 H Li r[J�..
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?
$ 145,246.81 WIYes ❑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
LNBCommunity Bank — �o2
Addresss of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Drawer NO
Address of assignee(number and street,city,state,and ZIP code)
Card NO.
Does applicant own property in any If yes,what county? What Taxing District? of deduction
other county
in Indiana? ❑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
Signature of County Auditor County Date(month,day,year)
L a.V,A4rY , - .. Gibson 03/08/2021
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.
Signature( r's full name) � 16-g71--) Date(month,day,year)
) 3/8/2021
Full resident address o applicant(number and street,city,state,and ZIP code)
7131 E 500 S., Francisco, IN 47649
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 periury can include imprisonment up to two and a half years and a fine'not to exceed$10.000.