HomeMy WebLinkAboutMortgage_Douglas (5) "'na STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
S4.
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) Gibson Montgomery 2015
Prescribed by Department of Local Government Finance
F le-Mark
INSTRUCTIONS: I I
To be tiled in person or by mail. Form filed cairn: ;
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 0 County Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located 2 on or before January 5 of the immediately succeeding calendar year. JUN 2 3 hrl '`1.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 side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AliDITOF
Blane A. Douglas
Taxing District Key number/legal description dn
Recsrdnul a Page n umber
Montgomery 26-17-01-400-000.704-021 OO'(()) Q100
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sale
March 1,current year March 1.current year date of application legal or equitable owner?
84,200 122,048 GI 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
O Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Rapid Mortgage (Qmoc,r.
Address of mortgagee or contract selr(number and street,city,state,and ZIP code)
272 W Central Ave. Springboro,OH 45066
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 GI 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)
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 o e aforementioned property on date application is filed.
ignature o fs full na ) Date(month,day,year)
Y 6/19/2014
Ful sident ad s of applicant(number and street,city,state,and ZIP code)
5132 S 7 0 W,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)