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HomeMy WebLinkAboutMortgage_Buente (2) • • �. S STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count :S, IWJ'QLr FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R10/11-08) Gibson tpp Prescribed by Department of Local Government Finance A 020 10 INSTRUCTIONS: le Mark To be filed in person or by mail with the County Auditor of the county where the property is located. Filing Dates: I) Real Property:Must file during the year for which the deduction is sought. g ( / G I�S$OI .CkOUNT'�,� TOR 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months before a a the deduction is sought See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Theresa M.Buente Taxing District Key number l legal description Record number Pa fh r men Ft.Branch 26-19-19-204-001.314-026/Lot 76 in Indian Hills Additions also lot 77 201300001731 Mussed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole March 1.current year March 1,current year date of application legal or equitable owner? S154,122.00 IN Yes ❑ No It no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom It name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed ©Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Fifth Third Mortgage Address of mortgagee or contract seller(number and street city,state,and ZIP code) 5001 Kingsley Dr.Cincinnati,OH 45227 Name of assignee or other owner or holder of mortgage (/}///,J' /J ile Address of assignee(number and street,city state,and ZIP code) Does applicant own property in any other I It yes,what county? What Taxing District? Has this deduction been requested on property county in Indiana? for current year? ❑ Yes ❑ 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 owner I contract buyer of the aforementioned property on date application is fled. Sgritu (owner's hn/namgt/) twat- Date(month,day,year) !�// /// 03/21/2013 Full resident address of applicant(number and street.city,state,and ZIP code) 7912 S 45 E Fort Branch,IN 47648 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)