HomeMy WebLinkAboutMortgage_Vincent STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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72--_,0,7,,. STATEMENT County Township Year
ev a FOR DEDUCTION FROM ASSESSED VALUATION ra
0.� ra � State Form 43709(RI 1 /6-09) �' :�• 2014
'1� J Prescribed by Department of Local Government Finance tle
INSTRUCTIONS:
To be filled in person or by mail. APR 1 Feed with:
Filing Dates: 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located /� 0 County Auditor
on or before January 5 of the immediately succeeding calendar year. J/L,,, County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Audittz gQf�tth�
county where the property is located during the twelve(12)months before March 31 of each / .JN COUNTY AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jeff Vincent and Charity Vincent
Taxing District Key number/legal description 26-17-32-100-004.310-021 /11168 W 1000 RefdAnyp)byr Pa/17m er/ „
S, Poseyville, Indiana 47633_ ff//✓✓( II/11 �lS� �/
Assessed value f real prop 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?
5108,800.00 'p-Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with who„(
If name on record is different than that of applicant,indicate below: Is the property in question: Annually Assessed
'9-Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Regions Bank
Address of mortgagee or contract seller(number and street city state and ZIP code)
2050 Parkway Office Circle, Birmingham,AL 35244
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? 7No for current year?
❑ Yes ❑ Yes O 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)
//We certify under 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.
it'-tu = ( wn is full name) Date(month,day,year)
) .K 3I Ii9t
Full e!.4'nt address of applicant(number and street,city,state, and ZIP code)
11168 W 1000 S, Poseyville, IN 47633
Person authorized by duty 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)