HomeMy WebLinkAboutMortgage_Pack��o STATEMENT OF MORTGAGE OR CONTRACT IND�4EIIN�S,S u Township Year
-� � FOR DEDUCTION FROM ASSESSED VALUATION�
��.' Siate Form <3709 (R71 / 6-09) q y Gibson Ft Branch 2012
�`,y; '/ Prescn0etl by Oepartment of Lacal Government Finaerz O CT J/�
NSTRUCTIONS: File Mark
�To be liletl in C'�' Parm fiied with:
person or by mail.
Filing Dates: 7) Real Property: Must be canpleted and daled in the calendar year for which the tleducti �� � County Auditor
Must be �(ed with fhe Counry Audifor or County RecoNer o/ the coun[Y r�he� 7����i� �R
on orbefore Jan�ary 5 of the immediafely succeedirrg calendar year. �'��� ❑ County Recorder
2J Mobile / Manu(ac7ured Homes nof assessed as Real P�opeRy Must file wiM the County Audifor ol [he
counry where the pmperty is bcatetl dunng the fwefve (12) monlhs before Maich 31 of each year the
deduction is soughf.
See reverse side 7or additronal instrucfions and quali/ications.
Appl'inm (oMner w wnt2ct b�yer - see resfriclrons on raverse sde)
Joshua T 8 Jill A Pack
Taairg Distria Key number J legal descri0�w+ Remrtl number Page numbe�r!
Ft Branch 2619-7&203-001259-026 Lts � 13 8 114 Indiana Hills oZ I�
Assessed vdlue of real property as of Mortgaga I Contraa i�Webledness unpaid as of Mortgage / Cmtract indebtedness unpa' as d Is It�e applimnt the sole
Mart�h 1, wrtenl year March 1, wrtent year tlate of application �egal or epmtade owner?
5295600.00 5249375.00 ❑� Yes ❑ No
If no, whai is �is I her ezact share of interest? I( oKned vnih someone oNer than spouse, intlinte wiN whom
It name on record is Gifterent Ihan Ihat W appGCanl, indiwte �ebw: Is the properry in puestion: AnnualtyASSessed
Alan and Candace A Falls ❑� Real Propetty ❑ Mnualy Assessed
Mnhiln HnmellC fi-t 1-71
NaTB o( rtrorly2yCe Of Caft2ct seiler
Fiflh Third Mortgage Company
Mdress of rtrort9a9ee or contrad setler (number arM strcet, dry, 5ate. an0 ZIP code)
5001 Kingsley Dr, Cincinnati. OH 45227
Name of assignee or oNer awner w holder of rtqngage
AtlEress o:
�
lircant own pmpeny in any aher
IM�ana? I—I Yes
approvee in Ne amounl of:
5ate. arW [IY c002)
Ifyes,whatmuni�? WhatTarirgDis
No
COUNN AUDITOR
� SosNuA.�
I
i I �5a�I8
20 _ � 20 _ � 20 � 20 _ � 20
20
�rawre o( -C�wnry AWitrn I Counry I Date I�m. tlaY. Year�
C !
I/ We cenity under Ihe pena o( perjury lha �he above arW (oregoing infortnafion is Irue and cortect and that Ihe applicant is a resident of Indiana and
owner / wntract buyer of �he aforementlonetl properry on date applicalion is filed.
Date (monN. day. ar)
10/21%2011
iDEm a00ress W applicanl (numGer arM street, city. 5ate, an0 LPCOde)
'� S 20 E, Fort Branch, IN 47648
auNOr¢ed by duy execuled Pawar MAttomey w by IC 67.1-12-U.7
MCress of auVwnzetl person (number enE street aty. sfate,