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HomeMy WebLinkAboutMortgage_Flegel II :Y.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year \44. FOR DEDUCTION FROM ASSESSED VALUATION - % � :-" State Form 43709(R13/10-15) 2019 �s !/ Prescribed by Department of Local Government Finance File Mark INSTRUCTIONS: To be filled 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 or postmarked with the County Auditor or County Recorder of the county where the ❑ property is located on or before January 5 of the immediately succeeding calendar year. County Auditor 2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the 0 County Recorder 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) Chris Michael Flegel II Taxing District Key number/legal description 26-18-13-402-000.956-026/404 N. Main Record number Page number St., Fort Branch, Indiana 47648 o4J1a S� 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? $88,000.00 0 Yes 0 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 © Real Property 0 Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Regions Bank d/eea Regions rMortgagem ILE Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 1 2050 Parkway Office Circle, Hoover,AL 35244 Name of assignee or other owner or holder of mortgage JAN 2 59 Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any If yes,what county? What Taxing District? Has thisMe'Qpc(� •-an Ais[ettR If yes,state amount of other county elliggaNY 16 deduction in Indiana? 0 Yes ® No current year? -.❑ Yes 0 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 20 20_ 20 20 20_ 20 Signature of County Auditor County Date(month,day,year) I/We certify under 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 application is filed. Signature(owner's lull name) Date(month,day,year) jad Full resident a dress of applicant(number Ind street,city,state;and ZIP code) 404 N Main St., Fort Branch, IN 47648 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 510,000.