HomeMy WebLinkAboutMortgage_Smith (2) r• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County potyn ip
t.:tel
FOR DEDUCTION FROM ASSESSED VALUATION �A®Be
S• i State Form 43709(R11/6-09) Gibson Ft. ranch
44- Prescribed by Department of Local Government Finance
Filt6k1 5 2013
INSTRUCTIONS:
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ,,,,A 77,- • _ di /
Must be filed with the County Auditor or County Recorder of the county where the properly is located -• by'r7:r'•Of
on or before January 5 of the immediately succeeding calendar year. GI:S•'1 CQUNvG`RAIJOITOR
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
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Heather A.Smith
Taxing District Key number/legal description Regard number Page number
Ft. Branch 26-18-13-101-001.111-026 �1 "1378
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,current year March 1,current year date of application legal or equitable owner?
139300 133600 12 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
Fl Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Wells Fargo Bank, N.A.
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) •
2701 Wells Fargo Way Minneapolis, MN 55467
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 ear?
for current Indiana? ❑ yes 12 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/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 properly on date application is filed.
Sign t re(own es full name) Date month,day,year)
c ,Q - 2-- - zoi3
Fu0 res' ent address of applicant(number and street,city,state,and ZIP code)
715 Kennedy Dr Ft. Branch,IN 47648
Person authorized by duly executed Power of Anomey 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)