HomeMy WebLinkAboutMortgage_Gentry (7)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count
a,�^r'oa
��. FOR DEDUCTION FROM ASSESSED VALUATION
Sr•� � Sta[e Fortn e3709 (R71 / 6-09)
�l PresrriCeE by Oepattmem of Local Govemmen: Finance
INSTRUCTIONS:
To be filed in person or 6y mail.
Filing Dafes: 7) Real Property: Musf be cwnplefed and datetl in Ihe calentlai year to� which the deduclion is sought.
Musl 6e Iiled with fhe CountyAudifor or Counry Recorde� of (he counry where fhe properiy is locafed A
on or be(ore January 5 0/ the immediately succeeding calendar year.
2J Mobife /Manulactured Homes nof assessed as Real Property: Mus1 �le wi7h fhe CountyAuditor of fhe
counry where (6e pmperty is locafed dunng the twelve (72) months be7ore March 37 0/ each year the
� deducfion is sought �
See reverse side /or addiuonal instrucfions and qualilcations.
Applicant (owner w conl2cf buyer- see resMClions m reverse sitic) _.
Year
CoIu1n�t� Audiror
1 �yrflyRecorder
�
�Ang �isVict Key number / legal tlescdption Remrtl number Page num�er
Patoka �72-16-t0.1:00.1.834_-0J Lot 3 Wrighi Sub ;�iiJ ( G 3� 3 3
Assessetl value W real prope ,ry as ot Mort9age / ConUacl inaeDtedness unpaid as of Mortqage / Convau indebtedness unpaiG as of Is ihe applicam Ne sole
Marfh 1, artmt year March 1, wrzenl year tlate of applicatbn legal or equitaWe oxnerl
$110,700.00 $0.00 5100,300.00 � Yes ❑ No
If no, what is Ns / �er exaa share of interesi? If owne0 w�N someone oNer Nan spouse. indiwte wiih whom
If name on recortl is diPerent �han �h
Nortnan
a[ of appliwnt. indiwte Celow: .
Henriette MfWhitehe�
Name ot mortqa9ee or convacl seller
Fifth Third Mortgage Company
Address of morigagee or mntract seller (num0er and streef, ury, slate,
5001 Kingstey Drive, Cincinnati, OH 45227
Name of assignee or other owner w holder ot mortgage
street. aty, sfa:e.
wm property
yes, what coun,y? � What Taeing Distnct?
Is the property in ques6on: MnuallyASSeued
�❑ Real Property ❑ MnualtyASSessetl
Has this de0uction been requeste0 on properry
forcurtentyeaR
❑ Yes ❑ No
COUNN AUDITOR
Deduction apP«etl in Ne amoun� of:
20 _ 20 _ 20 20 _ 20 20 _ 20 _
:ynawre of CounryAUditor Counry Date (monN, day, yea�
I I We certify under the penalty of perjury that the above and toregoing infortnalion is true and correct and that the appliwnt is a resident of Indiana and
owner I wn7act buyer of ihe af remenlion d property on date application is filed.
Signalure (o f full�ame) Oate (monfh, day, yeai)
oaiosnoio
Fu� resi re pp (numbe� arH she t. iry, s[are, and ZlP code)
584 Meadowlark Dr'rve, Pnnceton, IN 476 0
Person auttwrized by tluty execured Po.ver of Attomey or by IC 61.1-12-0.7 Data (monfh, tlay, year)
ACaress of authwixeE person (number ara sveet. ciry, sfafe. arM ZIP wCe)
�