HomeMy WebLinkAboutMortgage_Simmons (3) "'n, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION y�
4• - State Form 43709(R73/20.15) axe()r �i b3'!Y1 �)G
; Prescribed by Department of Local Government Finance
INSTRUC77ONS: File Mark
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 sought
Must be filed orposbnarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding.celendar year. ❑ County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property.'Must file with the County Auditor of the county
where the properly 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 resrric/ons on reverse side)
Michael C.Simmons , Katherine L. Simmons
Taxing District I Key number legal descry son Reco�&nu Page number
Gibson 26-12-07-104-002.486-028 /(J' v/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the appb - the sole
assessment date,current year assessment date,current year date of application legal••Y-stable gnapeR
72,300.00 86,500.0 '���.g{((- riper?
No
tf no,what is his/her exact share of interest? If owned with someone other than spou t w;h who i
11.--1 J II
If name on record is different than that of applicant,indicate below. Is property In quenstbm Annually Assessed
Real Proper O tMdb ly omAme(IC 6-1.1-7)
Name of mortgagee or contract seller Pitt�L 1M6U71�0i
Regions Bank d/b/a Regions Mortgage •
Address of mortgagee or contract seller(number and street city,state,and ZIP code) atemecair
2050 Parkway Office Circle, Birmingham, AL 35244 GIBSON COUATY AUDITOR
Name of assignee or other owner or holder of mortgage
Address of assignee(number and stree cry,state,and ZIP code)
Does applicant• perty In y If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county y dr on property for
in Indiana? air es No current year? ❑Yes ❑No
A person is not-naffed 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 I 20_ 20 20 20 20 20
Signature of County Auditor County Date(month,day-year)
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 property on date ap•ication is filed.
\5' atat_ure(o, ens�Oi me) l Date(month. ay,yearn
\ �1(/i; jers `-P� X .//4.,Z1.(r�2,. r6m`vi/vr�f/r(/J " Jv7(O//g
u n dent address of a nt(number end street,city,state,ardrZl•code)
115 E.Walnut Street, Princeton, IN, 47671
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 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 810,000.