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Leo STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CountyTownship
Year
f �`•y,i FOR DEDUCTION FROM ASSESSED VALUATI° � ��r ®
k*seri'�• State Form 43709(R13/10 15) b ® CIt�S�/1 QZ� ,
Prescribed by Department of Local Government Finance J
I�i6� DEC .1:12020 File Mark
INSTRUCTIONS: T•- , C
To be filed in person or by mail. ( F rm filed with:
Filing Dates: 1) Real Property:Must be co A eted 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.
Aoolicant(owner or contract buyer-see restrictions on reverse side)
Reeves,Russell Land BethaanyJ.
Taxina District Key number!legal description Record number
Pa um.Ar
Johnson 26-19-32-101-000.117-024/MACK CURTIS 21 !N Zr �
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?
156500.00 132000.00 148.800.00 Y 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. -- - --- -- - --- - _ _. - - Is-the-property in question:Annually_Assessed ___
x Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of moriaaaee or contract seller • F I x FL...,LI
Regions Bank dba Regions Mortgage ISAOA
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
2050 Parkway Office Circle.Hoover.AL 35244 DEC 1 4 2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
GIBSON COUNTY AUD TOR
Does applicant own property in any If yes,what county? What Taxing District? Has this deductio en requested If yes,state amount of deduction
other county ( on property for
in Indiana? ❑Yes No current year? Yes El No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or nt ct 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)tha is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 C_..... 20 20 20 20
Signature of County A OP
County r- Date into th,day.year)
flits,;4) 6 \�0 l� Ik4 'TQQ-0
II We certify under the penalty of perjury that the above and foregoing information is and correct and that the applicant i a resident of Indiana and
-- owner/contract buyerr ofthe aforementione-d"property on-date application is filed. -
5atII71 &kAitO ci-
Dat/(�nth/day,yZ07-0
Full resident address of applicant(number and street.city.state.and ZIde) (/ (//
569 E Eisenhower Ln,Haubstadt.IN 47639
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)
RECEIPT FOR FILIN STATEMENT OF MORTGAGE OR CONTRACT IND TEDNESS
Nameo( licant NameSf:r',... e
\Ill(` a aF celle
1 eQvcaJ.4 `;; ,
Date filed(month,day,year) Amount of debt a IlkiTaxing istric,L
IZ- � �r10 ; 420'007--"
Key nuT mb !legal description
r -o
•
Signaturey�.ow Auditor/County Re rder County ` DatgT..1th,�gay.year) _
--.. 1
�', GIB NTY AUDITOR [/� `v"1 ?i•Oct•O-