HomeMy WebLinkAboutMortgage_Rotramel STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I 1 o hi r
7/ ! FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
•• " Prescribed by Deparonent of Local Government Finance- vy�
INSTRUCTIONS: APR f(/ r
To be fled in person or by mail Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located , ei_ ou 3, .'t.
ty immediately succeeding year BSO M 711r�t/1. Recorder
on or before January 5 of immediate succeedin calendar ear. GI
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the C' 'Nry 2 _
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Patrick D.&Katherine E. Rotramel husband and wife
Taxing District Key number/legal description ' t Instrumen
Haubstadt 26-18-36-403-000.587-009 20130000170
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebteamt*OritiaidIas btFTLduidiaa spt Pti1WDEF
March 1.current year March 1,current year date of application pt4tablipownar?
121700.00 tlLplllfYPAA No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appbcant,indicate below: Is the property in question:Annually Assessed
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank
Address of mortgagee or contract seller(number and street,city.state,a ZIP code)
5001 Kingsley Or Cincinnati OH 45227
Name of assignee or other owner or holder of mortgage /' ,( ��f l
LA QYG (/ {_l y/�P� L LCY�/L /a3
Address of assignee(number and steel dry,stare.and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ yes Si No ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20_ 20 20_ 20 20
Signature of County Auditor County _ Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date Valpplication1is filed.
Signature(owner's/u0 name) �/,��i1 1 ._ .'^. _) Date(month,day,year)
J( r{I •If'II�/{LiN1N + 03/28/13
Full resident address of applicant(number and street city state,and ZIP code)
112 S.Campbell Blvd.Haubstadt IN 47639
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)