HomeMy WebLinkAboutMortgage_Matthews (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
40 FOR DEDUCTION FROM ASSESSED VALUATION
L`9i. State Form 43709(R13/10-15)
� ° Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
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 or postmarked 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 calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the 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)
MATTHEWS, LARRY A. and MATTHEWS, CHRISTINA J.
Taxing District Key number/legal description Record number Pag number
PATOKA 26-05-31-200-000.874-027/PT E FR 31 1 10 2.7779 AC. C-1 aQ aO �
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant ifTe sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
156,100 247,000 235,000 ❑ Yes El 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
eal 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 c=•
2050 Parkway Office Circle, Birmingham, AL 35`4I
LED
Name of assignee or other owner or holder of mortgage p� q
Address of assignee(number and street,city,state,and ZIP code) An 2 `on
Does applicant own property in any If yes,what county? What Taxing District? uction been requested If yes,state amount of deduction
oher count
ntlndana?y ❑Yes Nt< PATOKA t1 C , ry4 1.�;1'-s Ili No
A person is not entitled to this deduction unless the person has a balanc 3c tt drperson'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
Signature of County Audit County Date(month,day,year)
'I/We certify under the penalty of perjury t he aboved 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 full name) Date(mont ,,day, ear)
side ddres5 of applicant(number an s reet,city,state, d Z code)
280 E. OLD PETERSBURG RD, PRINCETON, IN 47670
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.