HomeMy WebLinkAboutMortgage_Ziliak (4) �E n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�4 J 49
� f, FOR DEDUCTION FROM ASSESSED VALUATION
�• State Form 43709(Ri 1 /6-09) 51 2014
'- s Prescribed by Department of Local Government Finance File Mark
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INSTRUCTIONS:
To be filled in person or by mail. o I filed!W. ,
Filing Dates:1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 11):
Must be filed with the County Auditor or County Recorder of the county where the property is located a 1- :• ditor
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
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(owner or for contract buyer-see restrictions son qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) •lh'N�
Kyle M.Ziliak and Sarah L.Ziliak GIBSON COUNTY AUDITOR
Taxing District Key number/legal description 26-18-36-400-000.813-009/805 W Gibson Record number Page number
Street Haubstadt, Indiana 47639 /n' ll
26-18-36-400-000.813-009 ^0 I - I I fLe
Assessed value of real properly 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 of equitable owner?
$160,000.00 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 a 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 Company
Address of mortgagee or contract seller(number and street city state,and ZIP code)
5001 Kingsley Drive,MD#1MOC BQ, Cincinnati, OH 45263
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?
0 Yes o ❑ 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 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.
jSignaturrpwners full nam to(month,day,year)
ni
Full sident address of applicant(number and street,city, state,and ZIP code)
805 W Gibson Street, Haubstadt, IN 47639
Person authorized by duty 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)