HomeMy WebLinkAboutMortgage_Valentine eci , •STATEMENT OF MORTGAGE OR CONTRACT I BEDNE S County Township Year
t FOR DEDUCTION FROM ASSESSED VAL q
• State Form 43709(R13/10-15) 8 J Gibson Haubstadt 2018•
� ', Prescribed by Department of Local Government Finance
INSTRUCTIONS: QCT 31 2017 File Mark
To be filed in person or by mail. Form filed with:
Filing Oates: 1) Real Property:Must be completed and dated in the calendar year for which e d o gig is sought.
Must be filed or postmarked with the County Auditor or County Rebdde ott where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding ca11ri�KK a.5.ry AUDITOR ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Proprtgsvp t Re-wrththe 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.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Laura A. Valentine
Taxing District Key number/legal description Record nu`pr Pape number
Haubstadt • 26-19-31-301-000.221-009 `Pot I"- clS 1 }
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
131,000.00 123,500.00 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
0 Real Property ❑ AnnualtyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Regions Bank d/b/a 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 operty in any If y what county? What Taxing District? Has this deduction bee requested If yes,state amount of deduction
other county on property for N5 • oQ�
in Indiana? Yes ❑No 1',son ��'t‘(1C,k.k(>n current year?deduction
❑No f(
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 recorders office)that is the basis for the deduction.
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 and he pen- y of perjury at the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
own-,/'contract, yer of• e aforement ned property on date application is filed. I
• ,ra e(owner' same) „ / _ t n Date(month.day,1r)r) tri
Full r sident addr ss. nt(number a d stre et,city.state,and ZIP code)
rt 2 , 0 N. Main ., Haubsta , N 47639
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.