HomeMy WebLinkAboutMortgage_Blanton ;..,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
\) FOR DEDUCTION FROM ASSESSED VALUATION Gibson Fort Branch 2021
:/I State Form 43709(R14 I 1-20)
�--_ Prescribed by Department r
LAA!Tj)✓ MA e— File Mark
INSTRUCTIONS: To be filed in person, s'� Form filed with:
Filing Date: Form must be complete, �--�'l / ( s sought. RI County Auditor
Must be filed or postmal )unty where the property is
located on or before Jai re first due and payable. ❑ County Recorder
See reverse side for additional instructions and quauuca...,.,....
Applicant(owner or contract buyer-see restrictions on reverse side)
Michael Blanton
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-18-13-401-000.660-026 2021 5986
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is thea applicant
the e sole
assessment date,current year assessment date,current year date of applicationlegal or equitable
$60,000 RIYes ❑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
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
5/3 Bank F I.T ie/E �■■'w��/
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) NOVName of assignee or other owner or holder of mortgage O 2 4 2021 t--4?,, ,,1/4„Th
Address of assignee(number and street,city,state,and ZIP code)
Fri��p ,,, Gu 1/�"
Does applicant own property in any If yes,what county? What Taxing District? 1-11X lT 3Q�Ir1gtfe114411IdnYrr ikiit@'�O f 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
Signature of County Auditor (��r County {r�yr` Datet t(month,day,yoear) t
\�,`(��` af^.I Ql_� 1 rc_i _ 1� l `ram t VD +,.cmot N . y` —. ..�"1 .c _
I/We certify under the penalty of perjury that the above and for got, 'formations is truetr and correct and that the applicant is a resident of Indiana an
owner/contract buyer of the aforementioned property on date ppli«�+ is filed.
Signature full me) Date(month,day,year)
X.
„i `-t------- 11/24/2021
FuII resident address of plica (number and street,city,state,and ZIP code)
304 W Ulen St., Ft. Branch
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)
------••.-•� ..in,I,.rfe imprisonment up to two and a half years and a fine not to exceed$10,000.