HomeMy WebLinkAboutMortgage_Sears • STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CDW ,�� �?�ia'
a FOR DEDUCTION FROM ASSESSED VALUATION
`- SWe Farm all09(R11 I5- )
it Preadibed by Department of Local Government Prance
I a Ma
INSTRUCTIONS:
Fong Dad in person or by mat Fogq ryes welt
Fling Dates: I)Reel Property:Must be completed and dated in the calendar year for which the deduction is sought �j�(fltl 1
Must be Ned with the County Auditor or County Reorder of the county wham the property is locate4,IBS D N
or
on or before January 5 of the immediately succeeding calendar yes Bo taw AularOR
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deductions sought.
See reverse side for additional instructions and qualifications.
Appian fawner or centred buyer-an restrictions an mans side)
Steven W.Sears
T Montgomery Key 6-17-0 legal 4.7ae c-�V C 3
Montgomery 2617-02-400-004.713-021/Lot 18 of Timber Lake S/D
Assessed value of real property e d MMgapa I Contract Indebtedness unpaid as d Mortgage/Centred indebtedness unpaid n d b the applicant the
Mardi 1,correct year Mardi 1.current year date d eppd albn legal or epuitede vents?.p13(:)+ 1,c0 17 yea ❑ no
If no.what is he I her'swan of interest? If owned with someone other sun span.indicate with whom
If name on record Is dleerae sun that of and ant.edkate below. 4 the property in aueslbn Annually Assessed
O Real Properly ❑fly Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or embed seller
Fifth Third Mortgage
Address of mortgagee or cmtrad seder(nrnba end Weal.cgs stele.end ZIP code)
5001 Kinglsey Dr,Cincinnati,OH 45227
Nere of assignee or other owner or holder of mortgage
Address of assignee(number end street city sun,end ZIP code)
Does aunty sppfican own property In any other It yea.what county?. WMI Tarty District? for Has thls current been raaueded on properly
In bit ❑ Yes 0 No Year?
❑ Yes ❑ No
COUNTY AUDITOR I
Deduction approved it Ow anent of:
20 20 20 20 20 20 20
Signature of CoWyAzalltor County Data(month.des.lea)
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 eta ' led property on date aa/� a t is filed. 0�a( Y�}Q97
Signature(owmh Ai name) ��
e7 �:Ji '- is
/ JI II t IT GU 13
psi resident address of eppiant(number and street city,date.and ZIP code)
Steven W.Sears/7981 W 500 S.Owensvme,IN 47665
' Person aahaved by duly executed Power or Attorney or by IC&1.1-12-0.7 I Dare(month.day.par)
_ —
Address of authorized person (nu ber end street city,stale,and ZIP rode)