HomeMy WebLinkAboutMortgage_Doerner (7) i„, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ft a ii FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609)
Presaibed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. el �ytn..
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. aaCoun(y Audilor
Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. t [ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the �
county where the property is located during the twelve(12)months before March 31 of each yeardn3SON
COUNTY AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
DANIEL J DOERNER AND MEGAN E DOERNER
Taxing District
601.3 3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1.current year date of application legal or equitable owner?
120600 50800 50800 O Yes ❑ 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
0 Real Property ❑Annually Assessed
Moble Home(IC 6-1.1-7)
Name of mortgagee or contract seller
REGIONS BANK DBA REGIONS MORTGAGE
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
PO BOX 1565,CORDOVA TN 38088
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on props try
county in Indiana? for current year? ❑ Yes ❑ No
❑ yes No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 _ 20 20 20
Signature of County Auditor County Date(month.day,year)
I/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 fled.
inn :u r=(ov(nefuOrWte) p?IemontkidaY.year)
Fun resident address of applicant(number and street.city,state,and ZIP code)
7522 S 1000E,ELBERFELD,IN 47613
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.ay,state,and ZIP code)