HomeMy WebLinkAboutMortgage_Ledford STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R14 I 1-20) Gson 026 2021
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form riled with:
Filing Date: Form must be completed and dated In the calendar year for which the deduction is sought. ® 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)
Ledford, Zachary R
Taxing District Key number/legal description Record number Page number
26-18-13-101-001.124-026 2021 6143
Assessed value of real property as of Mortgage I 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?
$65,000 ®Yes D No
If no,what is his I 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
FILE Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sellerOld National Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
DEC 14 Z021
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) /' u,,r,, _+�-..�-
GIBSON COUNTY ikuDITOR
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 0 No current year? ®Yes 0 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
Signaturr Co�� (Pr-4)
./�/1n hoc- \ County Date(month,day,year)
Gson 12/09/2021
1/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.
Sign to ers q a Date(month,day,year)
�f�J �,.. 12/09/2021
ull resident address of applicant(number and street,city,state,and ZIP code)
704 N Kennedy Dr, Ft Branch,IN 47648
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 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 INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Ledford, Zachary R Old National Bank
Date filed(month,day,year) ebt Taxing District
12/09/2021 a 0
026
Key number I legal description a Gi 114 3
26-18-13-101-001.124-026 1 •
Signature of Cou 4udit /-C)u ty Recorder DEC 14 Zu21 County Date(month,day,year)
Gson 12/09/2021
IthwiuttAotesoN CO6N'7Y ruD1TOR