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HomeMy WebLinkAboutMortgage_Osborne (2) 6�,, ,.'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co -- i � r�. , ear 4%- 4 %i FOR DEDUCTION FROM ASSESSED VALUATION - � State Font 43709(R10/11-0S) Gibson I Johnson Prescribed by Department of Local Government Finance AUG p ,Tj 2013 INSTRUCTIONS: File 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. t "11401.01 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)monl(1S it : W.41Jo �R the deduction is sought. GIBb See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Scott A.Osborne and Nathalie S.Osborne Taxing District Key number/legal description I Record umber Page number �dn Johnson 26-18-36-200-002.437-024/Lot Number#32 in the Plat of the Water i 3 q 18 Assessed 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.anent year March 1,current year date of application legal or equitable owner? 5173,500.00 © Yes ❑ No It no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom II 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 Kingsely 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? ❑ No for current year? ❑ Yes ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount ob 20 20 20 20_ 20_ zo_ 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/contract buyer of the aforementioned property on date application is filed. Siggature(owner's 7W name) Date(month,day,yea/) /TJ� 07/31/2013 Fun resident address of applicant(number and street,city,state,and ZIP code) 9654 S.Watertower Ct. Haubstadt,IN 47639 Person authorized by duly executed Prover of Attorney or by IC 61.1-12-0.7 I Date(month-day,year) Address of authorized person (number and street,city,state,and ZIP code)