HomeMy WebLinkAboutMortgage_Theising.+"��o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
��._y 4 FOR DEDUCTION FROM ASSESSED VALUATION
. � State Form a3709 (R77 1609)
- l Prescn6ed by DeDartment of Local Govemment Finance —
il M
INSTRUCTIONS:
To be �led in person or by mail. Form fited w�tn:
Filing Dates: i) Real Property: Musf 6e wmpleted and dated in the ca/endar year (or which fhe deduction is sought. II
Must be filed wifh tAe CountyAuditor or County RecoNer of the wunty where fhe property is located �u 0'�O�unry Auditor
on or be(ore January 5 0l the immediately succeeding calendar yeac Counry Recorder
2) Mobile / Manufactured Homes nof assessed as Real Property: Must file with fhe County Auditor oI fhe C.�
counfy where the pmperty is bcatetl dunng the tweNe (12) months before March 31 of each year the
deductionissought � ,,.,rv niiniTnw
See 2verse side /or additional instrucfions and qualifications. v""""• ""�•� •••�-- –��
Appticant(ownerw 9vaa6=er-s �eshiaio�i9verse \ e)
Dean C. Theisin �
Taun9 Distria Key nu ber/ legal descnpUOn Raco(d number Page number
Ft. Branch Township 26-19-1&302-000255-026 / Lot 31 in Hill ddition a0 �
Assessed value Ureal popeM1y as of Mortgage / CanVact iMebtedness unpaitl as of Mongage / Can•,raU inEeCtedness unpaid as ol Is �he apd��nt the sde
MaRh 1, artent year March 1, wrtent year data ol applicatbn legal or equitaGe owneR
5129,527.00 ❑� Yes ❑ No
If no, what is Ns / her ezact share of interest? If owneG vn�h someone oNer ihan spouse, indifata wiN whom
If name on recorC a Cifteren� �han Ihat of apptifant, iMicata bebvr. Is ihe praperty in Question: MnuaDy AssesseC
❑� Real Property ❑ Annuatly Assessed
Mobile Home QC 61.1-7)
Nama ot mortgagee or contrad seDer
Fifth Third Mortgage Company
ACEress of mortgagee w contraq seller (number arrtl sfreef, ury, sta:e, aM ZlPtode) '
5001 Kingsley Drive, MD: 1MOCBQ, Cincinnali, OH 45227
Name of assignee or mher owner or twider ol rtartgage
�tlress af assgnee (number anC sneef, dry, state. antl ZIP cotle)
Uoes applicanf ovm praperry in any o�her If yes, w�al wuny.+ what Taxing District7 Has mis aeaucuon Deen requesteC on pmperty
counry in InGana? ❑ for cunent yearl � Yes
❑ Yes / No ❑ No
COUNTY AUDITOR
Oeduction appfoved in Ihe amounl of:
20 _ 20 20 20 _ 20 _ 20 _ 20
Sgnature of CounryAUtliror Counry Date (monN, day, year)
I/ We cerOfy under lhe penalry of perjury Nai Ihe above and foregoing infortnation is We antl wrtect and that Ne applicani is a resident of Indiana and
owner / conJaU buyer of the aforementioned property on date applicaGon is filed.
S' re (owne/s fWl name) _ . d y.�a�
Full resident adtlress ol applican� (number slreef, city, sfafa. and ZIP code)
701 E. SinGair Ct., Fl Branch, IN 47648
Person authonzM by Cuty ezecutetl Power o( Attomey or by IC G1.142-07 Date (mmN. day, year)
Address ot authw¢ed person (nvmber and sreeC dry. stare, arid ZIP coEe)