HomeMy WebLinkAboutMortgage_Small..�^,�, STATEMENT OF MORTGAGE OR CONTRACT INDE
k.�.�'. � FOR DEDUCTION FROM ASSESSED VALUATION
i� %' Stata Pwm 43709 (Rl7 / 6-09)
�� – l Prevsibed by DeDartment d Local Govemment Finance
INSTRUCTIONS:
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To be �led in person or 6y mail. F�+����
Filing Dates: 1) Real Property: Must be completed and datetl in fhe calendar year7o� which fhe daducfion is sought. [� Cn�n�y U
Mus1 be �led wilh fhe CountyAUditor or Counry Reco�der of the counry where !he property is locafed gSQry COUNTY A� ITOR
on or be7oia January 5 ol the immediately succeeding calenda� yeat �� Counry Rewrder
2J Mobile /Manu/actu2d Homes not assessed as Real Property: Must file wifh the CounryAuditor o/the
munty where the property is low(ed dunng the fwelve (12) months 6e/we March 37 0/ each year fhe �
deduc[ion is soughL •
See `everse side 70� additional instrvc6ons antl qualifiwtions.
Applicant (owrrer or canVacf buyer - see resbiclions m reverse vCe)
BRYAN SMALL
Taung Districl Key number / legal Easmption RecorE numEer Page number
FRANCISCO 26-1319�-202-000.741-0OS/LOT 60 ORIGINAL PLAT TWN OF FR4NC1 ��
ftssessed value W real pmperty as ol Mortgage / Convaa iMeWedness unpaid as W Mortgage / Con•.raa intlebtetlness unpai as of Is ihe apqifant ihe sde
March 1, currant year March 1, wrtent year date of appliqtion legal or equitabla wmeYl
73,150 ❑� Yes ❑ No
I( no, what is his l her exact share oi interesl? I If owneG vnth wmeone other Nan spouse. intliwte wiN whom
1/ nama on reco�d is Eiflerent lhan Nat of applicant, indicate Debw: Is Ne property in question: MnuaOy As5e55eC
❑� Real Property ❑ Mnua�yASSessed
Mobile Home QC 61.1-7)
Name of rtwrtgagee w mnVact se0er
FIFTH THIRD MORTGAGE CO
Address ot mortgagee w conVad se0er (numDei antl streeG Wy. sfa:e, arM ZIP code)
5001 KINGSLEY DR CINCINNATI OH 45227
Name of assgnee or a:her owner or holtler ol rtartgage
Address ot auignee (number and s1reeG tlry. sfata. antl ZIP cotle)
Does app6cant own property in any oNer If yes, what tounry7 Whai Taxirg DisviaT Has Nis tleduUwn been requesteC on prope .ry
coun in InEiana? tar curteni ear?
ry ❑ Yes ❑ No Y ❑ Yes ❑ No
COUNN AUDITOR
DeCUCtion appfweE in Ne amwnt of:
20 20 20 20 20 20 20
Sgnature of CounryAudiror Counry Date (monN, Cay, yeaq
I/ We cerUfy untler the penaliy ot perjury Nat the above and (oregoing infortnalion is We and wrtec[ and that the applicant is a resident of Indiana and
owner / conVact buyer of the aforementioned pmperty on date applicaGon is filed.
Sgnat ( e s fufl na I Date ( N, Oa yea�
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Full en dress o( appliwnt (numDer arM slreef. ury, state, end LP code)
206 S 4TH ST FRANCISCO, IN 47649
Person auNOrized Dy duty executetl Power of Attomay w by IG 61.142-07 I Date (monfh. day. yeah
AEEress of auLwt¢etl person (number and s4ae( tity, sfale, antl ZlPcode)
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