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HomeMy WebLinkAboutMortgage_Johnson (24) �`' `., FOR DEDUCTION MORTGAGE OR ASSESSED VALUATION INDEBTEDNESS County Township I Year t• try State Fcrm 43709(R13/10-15) gg .Ny Prescribed by Department of Local Government Finance p �F116m� i� INSTRUCTIONS; g H 6 lb bellied M person or by men. Fpm with: Filing Deter 1) Real Properly:Must be completed and dated In the calendar year for which the deduction Is sought. Must be filed or postmarked with the County Auditor or County Recorder of the county where the gropes 3.0 7 , County Audtor boated on or before January 5 of the fnmedtatey succeeding calendar year. County Recorder 2) Mobile/Manufactured Homes not assessed as Real Properly:Must fib with Me County Auditor of the county where the property Is boated during the twelve(12)months before March 31 of each year the dedrktoV sought. See reverse side for ad(dNlonal Instructions and qualifications. Applicant(own °w��r-'[ctq(b�u�y��S[F/eseetee '°w aid°)(����•,�• GIBBON COUNTY AUDITOR Taxing Distrld V lsJber anal deseixl0n Record number Page number a -a© - ID-Ito-Q90.193-Co/ JO- , a,47 i Assaesed clue of reel property as of Mortgage/Contract indebtedness unpaid as of Mortgage l Contrail Indebtedness unpaid as of Is the appitxrt the sole assessment date,current year assess ld cop lQ dale of emanation legal or equ'�table owner — i (/O_ `r[S ❑ Yes ❑ No If no,what Is Ns!her exact share of Ethical? If owned with someone other than spouse,Indicate with whom II name on record b cifferent then that of applicant.Indicate below: Is the property In queston:Annually Assessed • ❑Real Property ❑ Amur yAssessed Mobile Rome(IC 8-1.1-7) Name ol mortgagee or contract sager • Regions Bank dba Regions Mortgage • Address of mortgagee or contact serer(number and sheet city.rate,end ZIP code) . 2050 Parkway Office Circle, Birmingham, AL 35244 Name of assignee or other other or holder of mortgage • Address of assignee(number and skeet,dh:stale.and ZIP code) Does applicant than property In any 11 yes,what county? Witt Taxing District? Has this deduclbn been requested if yes,sate amount of deduction other county on properly for In Indiana? Yes ❑No current yowl ❑ ❑ yea 0 N A person Is not entitled to this deduction unless the person has a balance on the person's mortgage or contract Indebtedness that is recorded in the county recorder's office(Including any home equity line of credit that Is recorded to the county recorder's office)that Is the basis for the deduction. COUNTY AUDITOR DeducOon approved In the amount of: 20_ I 20_ 20 20 20 20 20 Signature of County Audibr County I Date(month,day,par) I/We certify under the penalty of perjury that the above and foregoing I domnatbn Is true and correct and that the applicant Is a resldem of Irian and owner I contract buyer of the afore ntloned property on date application Is filed. Inn ern m 0 (month day,vet i1 O At u gN f e of appga d(hum sheet did rah,and?Pmde)S \ . I l U1 l/ _ C�umLs s..— 559 'v Le L00 euthodzed by duly executed Power of A 'tf by IC&1.1.1 aka north,day year) Address of authorized person (number and street city.state,and ZIP code) The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.