HomeMy WebLinkAboutMortgage_Baker�sq� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
e�; FOR DEDUCTION FROM ASSESSED VALUATION
�J� StateFOrmd3709(Ri1/6-09) Gibson Haubsladl 2012
T. ,.;; PreSCnEeO Dy Oepartmenl of Local Govemmenl Finance
�NSTRUCTIONS: File Mafk
To be filed in person w by mail. Fartn fJea with:
Filing Da�es: 7) Real Property: Must be compfe(e0 and daied in 1he calendar year7o� which the deduction !s sou� � g r�- nty utlitor
Must 6e (rled wilh the County Audifor or County Recorder o! tha caunty where t6e properfy is lo � �`'�� �
on or be%re Janoary 5 of fhe immediarety succeedirg calendar year. A=��_�; ecorder
2) Mo6ile /Manulacvu2d Homes nof assessed as Real Property: Musllile wifh �he CountyAnditor o! fhe
county where !he property is located dunng the fwelve (12) months be(ore March 31 o7each year fhe 1
deductionissoughC QCT 11 2���
See reverse side 7a atldifional insfructions and aualilicauons.
�plinnt (owner ar confrdcf buyer- see
Garon L. 8 Cindy J Baker
Haubstadi
A55essed value of �I property as of
MaRh 1. wrteM year
5158,300.00
Ii no, what is his / her e..act s�are ai
26-1&36-403-000.054-009 Lot 802 Blk B 2nd Add to West Heights Sub
Mortgage / Cmtrad i�Webtedness unpaid as d
Mard� 1, arren� year
name m rer.wd is OiRerent than that of appti�nt, indicate Oebw:
Jason 8 Brendy N Bryani
Name of rtrortgagee w contracl seller
Fifth Third Mortqage Company
AOCress ot mortgagee or contratl seller (numbu and sbeet, riry. 9ate. and ZIP code)
5001 Kingsiey Dr, Cincinnati. OH 45227
Name of assgeree or other ov.ner w hoMer of rtrortgage
street, cily. 9afe. antl ZIP code)
appliwnt rnrn D�7erty in any olher
y in IMiana?
n Yes
I�E
i 776.411.00
5omeone oNer lhan spouse,
II yes. what counry? � What Tazing Disbict?
as W Is Ihe applkant Ine sole
legal or equitaWe awnM
0 Yes ❑ No
Is Ihe pmperty in question: Mnwity Assessed
❑� Real Property ❑ MnuaAy Assessetl
Mobile Home UC 61.1
Has �his tleducom been requeste0 rn pmpenY
for wrreni yeaY?
❑ Yes ❑ No
COUNTY AUDITOR
Deduclbn apprwe0 in Ne artwunt oi:
20 20 20 _ 20 20 20 _ 20
Signawre d Cwnry AWitor Counry Date (monN, tlay, year)
I/ We certify urWer the penalry of perjury that the above and foregoing infortna6on is true and correct and that the applirant is a resident of Indiana and
owner / contrect 6uyer of Ihe aforementioned property on date applicalion is filed.
� Si9raWre (mvrre/slWl name) � Date pnm:h. day. yxa�
�° 09I302011
Fu0 resken[ aCCra55 0( appliGdnt (numDei aM stree( cify. 5ate, antl LP cotle)
803 W Elm St, Haubsiadt, IN 47639
Person auNw¢ed by duly esecuted Paver o(Attwney w by IC 67.742-0J Date (mmN. day, yea�
Pdaress ot aut7nrrzetl person (n�mbar end sbeee pry, state, erM ZIP coee)