HomeMy WebLinkAboutMortgage_McKinney (2) do; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
l e FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance
INSTRUCTIONS: pkt Mark
To be filed in person or by mail a arm /e r
Filing Dates: 1) Real Property.:Must be completed and dated in the calendar year for which the deduction is sought. r
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is .T1 0 ;)a'or
located on or before January 5 of the immediately succeeding calendar year. I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county I A/
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. - 0 2pi7
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) it
McKinney, Shawn J. G)Bs°N ( Y+((((i-
Taxing District Key number/legal description Record number'thin._r A,� tuber
Barton 26-20-05-200-001.630-001/PT SW NE 5-3-9 4.55 A /9 �3
Accessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,=rent year assessment date,current year date of application legal or equitable owner?
136,800 39,500 120,000 El 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
El 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, 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 If yes,what county? V',,71at Taxing District? Has this deduction been requested If yes,state amount of deduction
other county ,—, property for
in Indiana? Yes CI No _ current year? ❑Yes ❑No
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 in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of.
20 it 20— 20 20 20 20 20 —
Signature of Cou A or County 1 Date(mo y yea
:i l siA/i se L ._ A ._ . _ �� fib—/�
I/We certify under the pen, of perjury that the above OM tng information is true and correct and that the applicant is a resident of Indiana and
owner/ act buye a laeaforementioned properly on date application is filed.
Signal sto Date(nionth,ydd �1
ull - ie/r:•ress of applicant(number and street,city state,and ZIP code)
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.