HomeMy WebLinkAboutMortgage_LaFoe a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN y Township Year
�: FOR DEDUCTION FROM ASSESSED VALUATION?
j Slate Form 43709(RU/609) _►ILJ
JPrescribed by Department of Local Government Finance
INSTRUCTIONS: 2 1 2°14 File Mark
MAY
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction i so t.
Must be filed with the County Auditor or County Recorder of the county where t rop ed County Auditor
on or before January 5 of the immediately succeeding calendar year. n1 tDaTOR County Recorder
2,1 Mobile/Manufactured Homes not assessed as Real Property:Must file i t� Tiibr ditrie __
county where the property is located during the twelve(12)months be)�7ich 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
LaFoe,Jasmin N
Taxing District Key number/legal description Record numb Page number
Patoka 26-12-07-201-000.652.028 aQ I a018
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,current year co date of application legal ore itable owner?
-69;266':60 JC(Q( .CL 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 property in question:Annually Assessed
eal Property ❑Annually Assessed
// Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sager
Regions Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
7400 Eagle Crest Blvd., Evansville, IN 47715
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 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)
1 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 filed.
'gnatur els full name) Dt moglhysy,y r)
7 co;!
ay,
resi ent address of applicant(number and street,city state.and ZIP code)
604 North Gibson,Princeton,IN 47670
Person authorized by duly executed Power of Attomey 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)