HomeMy WebLinkAboutMortgage_Lee (5) .M0mk, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownshipYear
i' `=�'�• FOR DEDUCTION FROM ASSESSED VALUATION
' Viz- L91 State Form 43709(R14/1-20) G'son 021 2020
\y""'i=4° Prescribed by Department of Local Government Finance
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File Mark
INSTRUCTIONS: To be filed in person or by mail.
Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. i] County Auditor
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 calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Adam/Julia Lee
Taxing District Key number/legal description Record number Page number
021 26-10-35-300-004.388-021 2020 2514
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applican a sole
assessment date,current year assessment date,current year date of application legal or equ' le owner?
$192,500 es ❑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 ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Regions BankFILFD
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage N U V 2 3 2020
Address of assignee(number and street,city,state,and ZIP code)
pp property y county? Taxing d�fct sted If yes,state amount of deduction
Does applicant owninan If yes,what What Distr SON 1001Mi V T
other county on property for
in Indiana? Yes No current year?
❑ III ®
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 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 0 20 20 20 20
Signature of Ccii,7
Auditor/ C County
,S Date(month,day,year)
11/23/2020
I/We certify under the penalty of perjury that the above and foregoing information is t u nd correct and that the applicant is a resident of Indiana and
act buyer of thg aforementioned property on date application is filed.
, ,e s full na e) i Date(month,day,year)
11/23/2020
Full resident address of applicant(number and street,city,state,and ZIP code)
8021 W 400 S , O'ville, IN 47665
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)