HomeMy WebLinkAboutMortgage_Johnson (21) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R13110-15) sop '- P.tinceto 2018
Prescribed by Department of Local Government Finance II '
INSTRUCTIONS: • I 1
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 is sough B tl 'I 2 Z I'
Must be filed or postmarked with the Couny Auditor or County Recorder of the county where the p I I County Auditor
located on or before January 5 of the immediately succeeding calendar year. ■ Co ny Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile with the County Auditor of this aunty a
where the property is located during the twelve(12)months before March 31 of each year the deduct ..teryllt j,
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Paul K. Johnson and Anita K. Johnson
Tatting Distrla Key number/legal description Re nu;;}}ke�r Paaelursn9erL
Princeton 26-12-08-103-001.322-028
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Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
assessment date,=men:year assessment date.current year date of application legal a equitable owner?
62,700. 73,000 Yes ❑ No
If no,whet is his/her exact share of interest? If owned with someone other than spouse,Indic to with whom
If name on record is dC,erent than that of applicant,indicate below: Is the property In question:Annually Assessed
O Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or convac 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 y If yes,what county? What Tatting District? Has this deduction been requested If yes,sate amount of deduction
other county on property for
in Indiana? Yes 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 fine 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 oh
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/contact buyer of the aforementioned property on date application is filed.
Signeturafowne(s full ) Date(month,day,year)
/ dl/• /� 1 � _ 7 - 7— / 7
Pull resident address of applicant(number and street city,state,and ZIP code)
910 E Broadway St. Princeton, IN 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Dam(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 810,000.