HomeMy WebLinkAboutMortgage_Mallory (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESScounty Township I Year l
;::\ FOR DEDUCTION FROM ASSESSED VALUATION I 2021 I
ai,� f�, State Form 43709(R14/1-20)
itis
__-;; File Mark
� - Prescribed by Department of Local Government Finance Vor\
INSTRUCTIONS:
To be e inperson or mail. Fo�d with:
Filing Dates: Form must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the County Auditor
property is located on or before January 5 of the calendar year in which the property taxes ae first due 0 County Recorder
and payable.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Tori D. Mallory
Taxing District Key number/legal description 26-23-06-100-000.139-009/500 E Plum St. Record number Page number
0139 Haubstadt, Indiana 47639 j
11�
26-23-06-100-000.139-009 ;�62 1
27-6
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli t the sole
date of application legal or uitable owner?
assessment date,current year
assessment date,current year $144,900.00 Yes 0 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 pr rty in question: Annually Assessed
al Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Springs ValleyBank&Trust Company )F T L E D
Address offmortgagee
o
or contract seller(number and street,city,state,and ZIP code
1500 Main Street,Jasper, IN 47546
Name of assignee or other owner or holder of mortgage
NOV 2 4 7071 •
Address of assignee(number and street,city,state,and ZIP code)Does applicant own property in any If yes,what county? What Taxing r i t e ua
• ,^_ _,, •een requested f yes,state amount of
other county
GIBSON COUNIi"PlioI4}®f' • - deduction
in Indiana? 0 Yes 0 NoL„," current year? 41 Yes
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or c,! tra• 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) hat is he basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 1 20 20 20 20
Signature of Count AudioAt: County Date(man ay,lar)
IC\ \\ e 7n'�'2-�the enalt of er'u the above and ff/o'-T�',�\oing information is true and correct and that t e apant is a resident of Indiana
I/d o certify under penalty perju on date application is filed.
and owner/contract buyer of the aforementioned property p Date(month,day,year) /
Signature(owner's�ftulll-name) — J
-
Full resident address of applicant(number and street,city,state,and ZIP code)
500 E Plum St., Haubstadt, IN 47639 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)
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