HomeMy WebLinkAboutMortgage_StaplesM• rn.o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
M1d._,.. � FOR DEDUCTION FROM ASSESSED VALUATION �ibson Ft. eranch zot3
�j SUte Fortn 43709 (R77 / 6-09)
� ;� Prescnbed by Department of Local Govemment Finance �
� �� File Mark
�RUCTIONS:
rled in person o� by maiL Form filed with:
g Dates: 1) Real Pmperty: Must be comple[ed and dated in the ralendar year for which the deduction is soughL � County Auditor
Must be (led with the CountyAuditor or Counry Recorder o/ the county yyhBr�tl(� ��rty is loca[ed
on or belore January 5 0/ the immediately succeeding calendar year. MNI ❑ County Recorder
2J Mobile / Manufactured Homes not assessed as Real Property: Must �/e with the t uditor o( the
county where the property is located dunng Ihe hvelve (12) months be('or o ch year the
dedudion is sought.
Seeieversesideforadditionalinstructionsandaualifications. _._..,.,,rni1N7YAUDITOR
Applicant (owner or contrad b�yer - see
Tyler W. Staples
Taxing DiSirict
Ft. Branch
Assessed value o( real propeM � of
March t. arteni year
on
Key number / le9al descriplion
26-1318303-000.544-026
Mortgage / ConUatl inEE
March 1, wrtent year
If no, what is �is / her e�ct share of interest?
If riame on record is difterenl ihan
Name of mortgagee or contrad seller
Fifth Third Mortgage Company
Addreu of mortgagee or conVact seller (number end sfreet, cify, state, and ZIP code)
5001 Kingsley Dr., Cincinnati, OH 45227
Name of assignee or oNer owner or holder of rtartgage
assignee (number ernl sfree(, dry, state, arM ZIP code)
own property in any olher
ia?
❑ Yes
Deduction apprwed in Ne artaunt
20 I 20
If yes,
20 _ I 20
as
Page number
�rtgage / ConVact indebtcdness unpaid as of Is the aDPGpnt ihe sole
e of application legal or equitable ownert
139,897 ❑� Yes ❑ No
If owned vrith someone oNer ihan spouse, indirate with whom
I I We certify under the penalt�of perjury that e ab ve and foregoing informatio�
owner I conVact buyer of ihe aforementloned property on date application is filed.
nat wne(slu/lname)
^ �
/Jic /��
II re' ent a dress of applicaN (number and sfreet, city, stale, end ZIP code)
500 E. Strain St., Fort Brench, IN 47648
�onzed by Duty ezewted Power of Attomey or by IC 6-1.1-12-07
authorized person (number and stme(, ciry, state, and ZIP code)
Is Ne property in question: Mnualy hssessed
❑� Real Property ❑ Mnually Assessed
Mobile Home (IC 61.1-
Has lhis deduclion been
forwnentyear?
20
Date (rtanth, day, yea�
20
P�oPehY
n No
correct and thai the applicant is a resident of Indiana and
Date
day, yea�
OS/07/2012