HomeMy WebLinkAboutMortgage_Gaines (2) N STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township
s FOR DEDUCTION FROM ASSESSED VALUATION '
6 d Slate Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance �t �'•�'•!rm -II
INSTRUCTIONS: - v CIF•I r
To be filed in person or by mail. Fo ‘Ii-
Md':
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. MAR 2 J
Must be filed with the County Auditor or County Recorder of the county where the property is located County Auditor
on or before January 5 of the immediately succeeding calendar year. ll _ • -ecorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the . -sr
county r
county where the property is located during the twelve(12)months before March 31 of each year th- r - • `•',"•'
deduction is sought. .GIBBON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jonathan P.and Jennifer F. Gaines husband and wife
Taxing District Key number I legal description Record number Pa pymlbe{.,
�1..3ortvia 1l-D 26-17-12-101-000.086-022/Lot 2 Woodbree Addition to the Town of Owe 2)1.r5 y1 l//{V(
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as o Is the applicant the sole
Mash 1,current year March 1,current year date of application legal or equitable owner?
74000.00 13 Yes ❑ 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 applicant,indicate below: Is the property in question:Annually Assessed
151 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third
Address of mortgagee or contract seller(number and street.city state.and ZIP code)
5001 Kingsley Dr MD 1MOCBQ Cincinnati,OH 45227
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,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 is 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/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
own- ■ntract buyer of the aforementioned property on date application is filed.
'�. •w•erst 1 _ Date(month,day,year)
PA Fig ,, a.-.�Th ��/r} ,�1Nµ.Q;,Q.6 03/12/13
/r esident address of applicant(number and street city state,and ZIP code) _ (�
103 Woodbree Owensville,IN 47665
• 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)