HomeMy WebLinkAboutMortgage_Bass (2) qIfi,�4m STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
x� ;.rti e FOR DEDUCTION FROM ASSESSED VALUATIONA �Q �O
`�S` Slate Form 43709(R13/10-15) 05S--e Prescribed by Department of o Governm t Finance
remINSTRUCTIONS: /-�� GYV)
File Mark
To be fled in person or by mail. �.Jw I F m ed with:
Filing Dates: 1) Real Property:Must be completed and dal d in the calend year for is the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorde 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)
Christopher Bass and Amy Bass, husband and wife
Taxing District Key number/legal description ReeMircii6 P r
Princeton 26-12-07-104-002.672-028 I
Assessed value of real property as of Mortgage I 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?
$116,161.00 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: y4s the p petty q•- Lion:Annually Assessed
F 1 �✓ Re rop-,rty -@l Annually Assessed
.kt. i I ! ,, Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Regions Bank d/b/a Regions Mortgage DEC 1•
2020
Address of mortgagee or contr ct seller(number and street,city,state,and ZIP code)
20 ! -arkway O ce Circle, Birmingham, AL 35244 A
Nam=of assi• ee or her owner holder of mortgage r
GIBSON COUNTY as€�,I�-nR
Address o - sig -ebm an street,city,state,and ZIP code)
Does applicant ow p•• in an If yes, t co nty? �)What T xing District?
'V t? Has this deductio en requested If yes,state amount of deduction
?nit
th wunty on property for
in In ' na? •Ye ��NO 0 current year? Yes El No
A perso t entitled to this de ti nless the Von has a balance on the person's mortgage or tract indebtedness that is recorded in the county
recorde s ffi (inclu ing ar ho a equi •Irr that is recorded in the county recorder's office)that is the basis for the deduction.
( COUNTY AUDITOR
uclion approved in he \of:
20 20 20 20 20 20 20
Signature of County Auditor County Date tonch, ay,ye r)
(\ t--
I/We certify under the penalty of perjury that the above and foregoing information i e and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date a lication is filed.
Signature(ow fs full e) Date(month.day,year)
� `60 08/14/2020
Full rest add ss of applicant(num and street,city,state,and c�t/
429 rince St., 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)
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