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Mortgage_Lunghuhn ., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year 1 FOR DEDUCTION FROM ASSESSED VALUATION "� � State Form 43709(R13/10-15) RECEIVED QQ ,)pn . ©)T 1-oza \1 e� Prescribed by Department of Local Government Finance J ,,eL. INSTRUCTIONS: 1� II '�a I MAR 1 1 2022 File Mark 1 �-�-1` To be filed in person or by mail. Fo led with: Filing Dates: 1) Real Property:Must be and dated in the calendar year for which the deduction is sought. Y Count Auditor Must be filed or postmark d 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 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) lunghuhn,Rebecca H Taxing District t''— Key number/leaal description 'Record d number Page number Patoka lk.)J [J 26-05-32-400-001.189-027/PT SE 32 1 10 1.4871 AC C-1 1 2_O -?__2__ cq u 0 Assessed value of real property1f Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment date,current year as.e.cment date,current year date of application legal or equitable owner? 110700.00 168000.00 161.000.00 x 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 morta or contrail seller FILED Regions Bankk db dba Re¢ions Mortgage ISAOA/ATIMA Address of mortgagee or contract seller(number and street,city state,and ZIP code) 7050 Parkway Office Circle.Hoover_Al.35744 \A MAR 1 6 2022 Name of assignee or other owner or holder of mortgage IYI Address of assignee(number and street,city.state.and ZIP code) Glg$ON COUNTY AUDITOR Does applicant own prope•N in ny If yes,what county? What Taxing District? Has this deductio n requested If yes,state amount of deduction other county v on property for in Indiana? ❑Yes �/No current year? Yes ❑No A person is not entitled to thi deduction unless the person has a balance on the person's mortgage or n 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 20 20 20 20 20 \ r Signature of County Auditor n _ (R) County 10\\,Qr Date�m h,�q y r)_ �� I,We certify under the e�of perjury that the bove and foregoing information is tru. afld correct and that the applicant s a residentl of Indiana and owner/contract buyer of the aforemention pr rty on date application is filed. ,r flat full ate onth, y.year) -/�''/'/{� 2- l4/ZOZL . F II rest ent address of applicant(number a d street.city.state.and ZIP code) / 1285 E 200 N.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.