HomeMy WebLinkAboutMortgage_Bulcherd�="o STATEMENT OF MORTGAGE OR CONTRACT
-��? FOR DEDUCTION FROM ASSESSED VA�
3• • StateFortn43709�R10A1-08)
��l PrescnbeE by Department ot Local Govemment Finance
Gibson I Johnson
INSTRUCTIONS: nr C 2 O ZO12 File Mafk
To be filed in person or by mail with the CountyAuditor o7 fhe county where the propeiiy is locafed.
Filing Dafes: 7) Real Property: Mus( file during the yeai lor which 1he deduction is sou$h
2J Mobile /Manu/acfured Homes nof assessed as Real PropeRy: Mus167a ng fh el 72) mon[bs belore March 37 0� each year
the deduction is sought 6�qS0 �NTY AUD�TOR
See reverse side for addifional ins(ruc6ons and qualifiwtions. N C�
� AnoGfanl fowner or cont2cf bwer - see reshicfians rn reverse sidel
Travis Wayne Bulcher
Tazing DisMCI Key number / legal desviption Recortl number Pa e nu ber
Johnson 26-1&31-100-001.733-024/pt of the NE Qir. of the NW Qtr. of sec 31 �° Q � � � Q
Assessed valua af real property as ol Mortgage / ConVaa indebtadness unpaiE as of Mongage / Con•vacc indebtedness unpaid as of Is iha appliwnt Itie sole
March 1. artentyear March 1, curtent year date of appfica;ion legal w equitade owner7
581,496.00 0 Yes ❑ No
It no, what is his I her exaG share of interest? . I It owneE wiN wmeone oNer Nan spouse. indrcate vnih whom
It name on record rs Eifferent ihan that ol appBwnt. indiwle bebvw Is Ne v�venY �� 4uestion: MnuaAy Asussed
❑X Real Property ❑ Mnualy Pssessed
Fifth Third Mortgage
Address of rtartgagee w mnVad seller (numberand sveet, ciry, sra�e, eM Z/P code)
5001 Kingsley Dr. Cincinnati, OH 45227
Name of assignee or oNer owner or hdder o( rtar:gage
AGdress of assignee (nvm0er an0 streel, crty. sfate. antl
ooes appliwnt own property in any i
wunry in Indiana?
n Yes
No
yes. what counry? � What
Has Nis deduction Ceen requesteC m property
(or curtem yean
❑ Yes ❑ No
COUNTY AUDITOR
Oetluction appmve0 in Iha amount of:
20 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
SgnaWre of CounryAUEi:or Counry Date (mmfh, dag yeafj
I/ We certiry under Ne penalry ot perjury that the above and foregoing informaGOn is We antl wrtect and Nat the appliwnt is a resident of Indiana and
owner / conVact buyer of the aforementioned pmperty on date application is fded.
Sig ' (o»neh lull name) Date (manth. day, yea�
12I14/2012
Fu0 resitlent aCGress of � piicant (nvmbe� an0 sUeet. ciry, stafe, arM ZIP cotle)
120 W 975 S Haubstadt, IN 47639
Person auUwnzeC by duly executeC Power of Attomey w by IC 61.1-12-0.7 I Date (rrwnN. tlag yea�
Atltlrass of aWwr¢ed person (numGe�arM streeC ciry, stare, arM ZIP cotle)