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STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
State FOrtn 43709 (R71 / 6-09�
Prescribed 6y Department of Loral Govemment Finance
Gibson
IN TRUCTIONS: 1
�led in person or 6y maiL � Form flee wit
Dates: i) Real Pmperty: Must be completed and dated in the calendar year (or which fhe deduction is sought. %.
Must be Tfed wifh fhe CowryAuditor or County Recorder ot the county where the property is located QY �' °�
on or before January 5 0/ the immediatety succeeding calendar year.
2) Mobile / Manufactured Homes not assessed as Real Property.' Must �le with the County Auditor o/ the -�.
county where the property is lorated dunng the Rvelve (12) months be/ore March 37 0/ each year the
deduction is sought. ,.,sonu rni iurv
Year
2013
Auditor
Recorder
See reverse side tor addifional instructions and qualifications. """"'"' �---�
Applicani (owner or contrau buyer - see restnctions on leverse si0e)
Jessica R. Beste and Joshua M. Beste
Taxing Distnct Key number / legal description Record number Page number
Montgomery 26-1436-101-001.270-021 Q/
Assessed value of mal property as of Mortgage / ConVacc indehtedness unpaid as of Mortgage / ConVacl indebtedness unpaid as of Is Ne applipnt Ne sole
MarM 1, arrent year March 1, wnent year date of apphcation legal or equitable o.mer?
153,700 120,000 ❑� Yes ❑ No
If no, what is his / her ewcl share of interest? If owned wilh someone other Nan spouse, indiwte vdth whom
If name on record is difrerent Nan that of applicant, indicate belovr. Is the property in question: Mnuallyhssessed
❑� Real Property ❑ MnuaOy F�ssessed
Mobile Home (IC Cr1.7-7)
Name of rtrortgagee or contract seller
Fifth Third Mortgage Company
Address of mortgagee or mntract seller (number and streeG ciry, siate, and ZIP code)
9400 S. Cicero Ave. Oak Lawn, IL 60453
Name of assignee or oNer owner or holder of mongage
Address of assiqnee (number and sfraeC city, state, and ZIP code)
applirant own pmperty in any other If yes, what munry? VJhat Tazing Dislrict7 Has this deduction been requested on property
, inlndiana? O No forcurtenlyeaR � Yes ❑ No
❑ Yes
COUNTY AUDITOR
Deduction approved in the artaunt oC
20 20 _ 20 _ 20 20 20 _ 20 _
Signature ot Counry Audimr County Date (month, day, yea�
I I We certify under ihe penalry of perjury Ihat the above and foregoing informatlon is true and correct and ihat the applicant is a resideni of Indiana and
owner / conVact buyer of the aforementioned property on date application is filed.
Si t e(owner Iul nam ) Date (month, day, yea�
05/1 i12012
II resident aEd ss of applicant (nu ber arM sneei. ciry, slate, and ZIP oode)
6657 W. 400 S, Owensville, IN 47665
Person authonzed by Euy executed Power ofAttomey or by IC 6t1-72-07 Date (monfh, dag year)
Address of authorized person (number and st2et, uty, state, and ZIP code)