HomeMy WebLinkAboutMortgage_Leible (3) by STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count j' qy t' r Year
E._ _ 1 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RIO/11-08) - 1,7
Prescdbed by Department of Local Government Finance
INSTRUCTIONS: - I• •a- 20!4
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
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mitre r,�crtyear
the deduction is sought. COON �KAA
See reverse side for additional instructions and qualifications. 1T AUD)tOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Carolyn D.feible L1
Taxing District Key number/legal description Record number Page number
Ft. Branch Township 26-19-18-101-001.149-026 00 It( (DQ /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
current March 1. ment year March 1.current year date of application legal or equitable owner?
289900.00 261500.00 13 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
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Great Western Financial Services
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5408 W.Plano Parkway. Plano TX 75093
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 ❑ No ❑ 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)
11 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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
Full resident adRRres�s of applicant(number and street,city,state,and ZIP code)
gob 1 tchO,Eo •��r. # �Urant A nt &vii 4�
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)