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HomeMy WebLinkAboutMortgage_Clore (2) e j=:+� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS inLi-inp I Year I i.• ; FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R10/11-08) ,,,;, Prescnbed by Department of Local Government Finance I n 2 9 I INSTRUCTIONS: MAY -•n:u '&Mark To be filed in person or by mail with the County Auditor of the county where the property is located. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. q�� 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12) h 31 cif each year the deduction is sought. GIBSON COUNTY AUDITOR See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) MICHAEL V CLORE Taxing District Key number/legal description Record number Page number FT BRANCH 26-19-18-303-000.519-026/60 FEET OFF ENTIRE SOUTH SIDE OF Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness PISS;the a a de Mardi 1.current year March 1,current year date of application legal or equitable owner? 85,050 © 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 ©Real Property ❑Annually Assessed Mobde 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 KINGLSEY 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? ❑ Yes ❑ No ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount of: 20 20 1 20 20 20 20 20 Signature of County Auditor I 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/contract buyer of the aforementioned property on date application is filed. Sig tore(own�f full na ) r n n _ Date(month.day.year) V If//r/�(IIJS.n�'/// 05/20/2013 Fu resident address of applicant(number and street.city,state,and ZIP code) 203 S WALTERS ST FT. BRANCH IN 47648 • Person authorized by duty 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)