HomeMy WebLinkAboutMortgage_Hernandez oA STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e._ ., s FOR DEDUCTION FROM ASSESSED VALUATION
2 1 State Form 43709(R10/11-08)
,t. c Prescribed by Department of Local Government Finance
F LE
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor of the county where the properly is located. FEB 2 4 2U14
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought.
2) Mobile IManufactured Homes not assessed as Real Property:Must file during the twelve(12)months before March 31 of each year
the deduction is sought. n,
See reverse side for additional instructions and qualifications. `T(JlY[l
Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR
Stephanie J.Garcia Hernandez
Taxing District Key number I legal description Rn Record num r Pace njbey-�
Montgomery 26-17-21-200-004.715-021 )
Assessed value of real properly as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness paid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
87300.00 72659.00 01 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 properly in question:Annually Assessed
❑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 slate,and ZIP code)
5001 Kingsley Drive,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)
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 0 N ❑ Yes ❑ NO
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20_
Signatur of County Date(month,day.year)
-)We certify under the p nalty 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 of ementioned property on date application is filed.
6igna e( s full name) Date(month,day.year)
([/�V ��1Q41 I4 .Qn��-- 4- S2)(gI fig
Full resident ddress of appli (number and street,city,state,and ZIP code)
9794 W.800 South,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 code)