HomeMy WebLinkAboutMortgage_Medler STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALI-}�( I,OI
State Form 43709(R11/6-09)
�'1 it
�,x;; Prescribed by Department of Local Government Finance $ g
File Mark
INSTRUCTIONS: SEP 9 2013
To be filed in person or by mail. Form idea with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. County Auditor
Must be filed with the County Auditor or County Recorder of the cou where e • ••-• ' located
on or before January 5 of the immediately succeeding calendar y:4 IMP..
❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Propert :Mu- ,A�yg�;r- r 4 q¢(p5 of the
county where the property is located during the twelve(1 SQ - • r ` . �•bMyTar the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
JOSHUA 0 MEDLER KRISIE L MEDLER
Taxing Distract Key number I legal description Record number pPage number
JOHNSON 26-18-34-400-002.233-024 /3 -417q0
q0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
208000 218000 218000 O 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. Is the property in question:Annually Assessed
Q Real Property ❑Annually Assessed
Mobile 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)
2050 PARKWAY OFFICE CIRCLE,BIRMINGHAM,AL35244
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 property
county in Indiana? for current year?
❑ Yes ❑ Yes ❑ No
No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sigmattuu ,,1County Auditor jot County Date(zapth, .year1,
I 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 iis� filed.
Syratur, owners:nil name) f 11 / '_7.(lLr,/' Date(monN.Cay,year)
!/'/ l.C� 9 30l3
ull resident address of applicant(number and street,city,state,and ZIP code)
2867 W SOYBEAN LANE FORT BRANCH IN 48648
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)