Mortgage_Mitchell�
��•,-'�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township � Year
i ; FOR DEDUCTION FROM ASSESSED VALUATION
' S�aceFOrma37o9(RIDm-0e) Gibson Johnson
-- "� PreSCnbeO by DeDartment of Local Govemment Finance
I
INSTRUCTIONS: F
To 6e filed in person or 6y mail with the County Auditor o! 1he counry where fhe properry is locafed.
Filing Dates: 1J Real Property: Must file dunng the year for which fhe deduc(ion is soughf. en �f 90
2J Mobile /Manufacmred Homes nof assessed as Real Pmperty: Musf fila dunng fhe twelve (72) months bePo�bl0rc1 31wb�h year
[he deductian is sought.
See reverse side (or atltlifional instruclions and quali�cations.
Applicant (owner w mn(ract buyer - see resfric(ians on 2verse side)
Shara L. Miichell and William L. Mitchell GIBSON COUNTY AUDITOR
TazingDisMCt Keynumber/legaltlescnptlon RecorEnumber Pagen�trum?Q t
Johnson 26-2316-400-001.924-024/Lot 4 in Country Ayre Estates 201300041195
Assessed vaae of feal properry as ot Mortgaga / CanGact indebtedness unpaid as ol Mortgage I Con•�aU indebtadness unpaid as of Is the applifant Ne sole
March 1, wrteni year March 1. artent year tlate of app6cation legal or equitade ovmeR
S160,000.00 � Yes ❑ No
If no, what is Ns / her exact share of in:erest? It owneE wiN wmeone oNer ihan spouse. inCicata wiN whan
It name on recorC is diAerent Nan that of applicant, indiwte Cebw: Is Ne propefty in question: MnuaDy Assessed
❑X Real Property ❑ MnualyAuessed
Mobile Home (IC 61.1-7)
Name of mortqaqee or conVact seller
Fifth Third Mortgage
Atltlress o( mortgagae or contract se0er (number antl streef, ciry, state, and ZIP code)
5001 Kingsley Dr. Cincinnati, OH 45227
Name ol assignee or oNer owner w Fwlder of rtwrtgage .
AEtlress of assynee (number antl slreet. city, sfate, and Z/P code)
Does apW��� � G�PenY in any other If yes, wtial munry? What Taring Disvitt9 Has Nis EeAudion been reQUested on property
counly in Intlian3? �or current yeaR cq
❑ Yes No ❑ Yes s�..i No
COUNTY AUDITOR
Detluc6on apProveE in ihe amount oE
20 _ 20 20 _ 20 20 20 _ 20
Syna;ure ol CounH Audi:w I Counry Date (monN, day, yea�
I/ We certify untler Ihe penalry ot perjury ihat the above and toregoing infortnation is trua and cortect and �hat Ihe appliwnt is a resident o( Indiana and
owner I conVact buyer of the aforementioned property on date applicalion is filed.
e(owne( na e) Date (mmN. day, yea�
02/25/2013
Full resitlent atlCress ol plicant (number anC slreef. ciry. sfale, anC ZIP coCe)
2202 E. Warrenton Rd. Haubstadt, IN 47639
Person authwizeC by duty executed Paxer of Attwney or by IC 61 J42-0] Da:a (monN, day, yea�
AGtlress ot aulhor¢ed person (number arM slreeL city. sfale. arid Z/P cade)