HomeMy WebLinkAboutMortgage_Keller a -tea STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year I
6 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
J Prescribed by Department of Local Government Finance
- Mark
INSTRUCTIONS:
To be filed in person or by mail. i o it filed
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. • for
Must be filed with the County Auditor or County Recorder of the county where the property is located
t on or before January 5 of the immediately succeeding calendar year. Mlny 2 my Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the //ii 1 l
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. P
Applicant(owner or contract buyer-see restrictions on reverse side) GIBBON
John G.& Keller COUNTY AUDITOR
Taxing District Key number I legal description Record number Page number
white River Township 26-02-58-030-000.913-018/Pt of Militia Donation 30 and 35-1-10 I aQ 13 13.1Or 4
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sae
March 1,current year March 1,current year date of application legal or equitable owner?
592,999.00 GI Yes ❑ No
If no.what is his I 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
O Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Mortgage Company
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
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?
ty ❑ Yes ❑ No y ❑ 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 I contract buyer of the aforementioned property on date application is filed.
Signatur rs 7u me) ♦i Date o=th,-day, --1
C\r(`(1
Fu resident address of applicant(number and street.city stare.and ZIP code)
7898 N.Cunningham Rd.Hazelton,IN 47640
Person authorized by duty executed Power of Attomey 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)