HomeMy WebLinkAboutMortgage_Lancaster o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-°z_ < FOR DEDUCTION FROM ASSESSED VALUATION
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1 -
• Slate Fon 43709(R11/6-09)
• n Presuibed by Department of Local Government Finance
ELLEID
INSTRUCTIONS:
To be filed in person or by mail. Form filedNf4h: O C '1(� t
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ❑Jl11CVV LI Audl(A
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. County Reco er
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 year the
deduction is sought. GIBBON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Ian C.'Lancaster and Amber L.lancaster9
Taxing District Key number/legal description Record number-1 Page number
COLUMBIA _26_1336200:001.247-0067 4 — c3 pl{85
Assessed value of real property as of Mortgage I 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?
293200 0 100000.00 Fl 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
Fl Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seler
REGIONS BANK DBA REGIONS MORTGAGE
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
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 a other If ygS,what county? What Taxing District? Has this deduction been requestedylpropery
county in Indiana? ❑ / ` k fo V for current year? � s ❑
Yes No l 1 CI 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 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 properly on date application is filed.
Sig cure(o /s fu0 name) Date(month,day.year)
�� C1 ?( -27-r �{
Full resident address of applicant(number and street,city,state,and ZIP code)
10367 E 250 S,Oakland City,IN,47660
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)