HomeMy WebLinkAboutMortgage_Williams (13)d� �o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun vnshi Year
ie�POR DEDUCTION FROM ASSESSED VALUATION
State Fortn a3709 (RN / 6-09) Gibson a s d
� Prescnbe0 by Departmen� of Local Gwemmen� Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail. F � �
Filing Dates: 7J Real Property: Must be compleled and datetl in fhe calendar year /or which (he deduction is sought.
Must ba filed with Ne County Audito� o� County Recorder of fhe county where fhe property is located C un udit
on or 6e/ore January 5 0/ the immediafety succeeding calendar year. ecorder
2) Mo6ile /Manufacfured Homes not assessed as Real Property Must file with the County Auditor o/(hF18S
county where the property is located dunng fhe M1veNe (72J monfhs belore March 37 0( each year the
deduction is sought.
See reverse side /or addi6onal insfmctrons and qualificafions. �
App4wni (owner w rontract buyer- sae resbictions on reversa sitle)
Julie N. Williams ��
Taung DisVict Key number / legal dascn0�� RecarC numCer Pag numDer
Haubstadt Township 26-1931-303-000.319-009 / Lot 208,209 8 210 in Town of Haubstadt � ��
Assessed value d real proper,y az N Mortgage / Convac� indebtedness unpaid as of Mortgage I ContraU indebtedneu unpai0 as of Is Ne appGCant ihe mle
MatM 1, artent year March 1. wrtent year Cate ol applicatbn legal w equifable ownel7
555,800.00 ❑� Yes ❑ No
I( no, whai is his! her exa<t share of interest? 1/ ovmeE wiN someona other t�an spouse, intlipte wi�h whom
If name m recoM is different Nan �hat of applicam, indicate bebvr. Is Ne propeM1y in quescbn: MnuaAy Assessed
❑� Real Pmperry ❑ AnnuaDy Pssessed
MoGle Home (IC 61J-7)
Name of mort9agee or conVact se0er
Fifth Third Mortgage Company
ACCress of mortgagee w contracl seAer (number antl strea4 cRy, Nate, end ZIP code)
5001 Kingsley Dr., MD: 1MOCBQ, Cincinnali, OH 45227
Name of assignee or other owner w twlCer af mor.gage
AdCress of assignee (number arM sbeef, dry, slafe. and ZIP coEe)
Does applicant a.m properry in any oNer If yes, what counry? What Taxirg DisVia7 Has Mis detluction been reQuestatl m property
counry in Indiara? for arrent YeaR
❑ Yes ❑� No ❑ Yes ❑ No
OeEuclian apprwetl
zo _ � 20 � zo _ � zo � zo � zo _ � zo _
Data (monlh, day, yea�
I I We certify under Ihe penatty of perjury that ihe above and foregoing infortnation is We and wrteci and thai the applicant is a resident of Indiana and
owner / contract buyer of the atorementioned property on date application is filed.
Fu0 Afsident aECress af epp4rant (number and sfieef. ury, state
201 S. Yne St., PO Box 373, Haubstadt, IN 47639
Oy1cG1J.f2-0.7
parsan �numOereMS(ree( pry,
Date (month, day,