HomeMy WebLinkAboutMortgage_Martin (20) d,.•!&r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �2c�
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State Form 43709(R14/1-20) Gibson 1
\; � Prescribed by Department of Local Government Finance �
a 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. m 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)
Glen E and Carrie A Martin
Taxing District Key number/legal description Record number Pa mberq
U0 26-19-18-304-000.148-026 02daa —75Q 1
Assessed 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 table owner?
$240,000 Yes ❑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: s e property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
LNB Community Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) ILED
PO Box 126, Lynnville IN 47619 F
Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city,state,and ZIP code) OCT 31+ 20221
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio b en requested f yes,state amount of deduction
other county on property for , eS FF��pp� _1/{„„41)
in Indiana? ❑Yes ®No current yea l� s3,f WTr.�/ tTOR
A person is not entitled to this deduction unless the person has a balance on the person's mortgage/llg u Cified91eon mat is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's o ice)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 Au itor ((;; County \ Date(m nth, y,year)
MU ins . "' 10 3‘ 'l�2 2- -
I/We certify under the penalty of ry that the above and foregoing information is u and correct and that the applicant i a r sident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
-Q-- OIYWpv/ q, z 3—w 2 a
Full resident address of applicant(number and street,city,state,and ZIP code)
806 E Walnut, 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.