HomeMy WebLinkAboutMortgage_Hensley (8) r—► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
°' A State Form 43709(R14/1-20) Gson 028 2021
�'» ,a a o Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. 64 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)
Hensley, Leonard Paul /Connie Sue
Taxing District Key number/legal description Record number Page number
028 26-12-07-103-001.172-028 2019 3926
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Iss the
applicant
the e sole
assessment date,current year assessment date,current year date of application 9equitable
er?
61,050 llYes ID 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 beloFI/T- "T'1 'T-� Is the property in question:Annually Assessed
j�,J• 1■■ L N- ��/_/ ®Real Property ❑Annua Assessed
Mobile Home(IC 6-1.1-7)
I
Name of mortgagee or contract seller
Royal United nF 2 .g021
Address of mortgagee or contract seller(number and street,city,77stt�att�e,""and ZIP c2Sd
Name of assignee or other owner or holder of mortgage Auc olzetze e
GIBSON COUNTY AUDITOR
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?
El VI 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
Sign f Coii gus //r ' 'C..\ County Date(month,day,year)
,$'Q 11 12/28/2021
I/ nder the pena of-o rjury that the above and foregoing informatio is t ue and correct and that the applicant is a resident of Indiana and
owner/-•ntr= on date ct buy-r of orementi ned props application is filed.
X Signature own: s full e)aig Date(month,day,year)
f / - 12/28/2021
Full r -d•r- o applican (numbs a street,city,state, d ZIP code)
04 W Emerson, P'ton, IN 47670
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)
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