HomeMy WebLinkAboutMortgage_Stevens _ 0
7.; "c STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
i_1 FOR DEDUCTION FROM ASSESSED VALUAT vv �_-
$tate Fans 43709 Department t of L I p E 't
� ,,;, ! Prescribed by Department o Local Government Finance �7pL J I File Mark
INSTRUCTIONS:
To be filed in person or by mail. I I I 77 pp t1 Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for WIt'th6®dABU is sought.
Must be filed with the County Auditor or County Recorder of the count,where the property is located ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year.L-C. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the my uditor of the
county where the property is located during the twelve(12)m bs before March o h year the
deduction is sought. �lBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) '
Roth A.Stevens 005 14 I OR I
Taxing District Key number l legal description 14 1,p 3•'5 c.11 Lo! y Record number Page number
4 Ste-2-15.13.K.
Montgomery Township 26-11-31-400 /
Ridge Estates cO 1a 3Q6 um pa
A«ssed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application, legal legal or equitable owner?
Si26-HRd7H{p l a 1135.00 Fl 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
GI 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.,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)
oes applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
..ounty in Indiana? for current year?
I El Yes 0 No El yes 0 N
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 filed.
Sign r is f 1 name Date(month,day,year)
Ail 1 3 2012
Full resident address of applicant(number and street,city.state,and ZIP code)
5660 W.Old Princeton Rd.,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 cede)