HomeMy WebLinkAboutMortgage_Bruner o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County pr s 1 ear
14_1 1 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RN/6-09) Gibson 15
�,.,. '' Prescribed by Department of Local Government Finance �g�/ Ac --
INSTRUCTIONS:
AU lay 20 r
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.
Must be filed with the County Auditor or County Recorder of the county where the property is located . ..go .; •- ,.
on or before January 5 of the immediately succeeding calendar ear. �� �:
N N 9 Y /r��18SO C*li «y: Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of N N DITO;
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)
Ryan W.Bruner
Taxing District Key number/legal desorption Record number Page�number
Ft. Branch 26-19-18-303-000.101-026 a0/1 3.5Q
Assessed valued real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I 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?
77,400 101,600 0 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
l 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 Dr.MD:1MOBA8 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? Mat Taxing District? Has this deduction been requested on property
county Indiana? for current year?
ty i ❑ Yes ❑ 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 f contract buyer of the aforementioned properly on date application is filed.
Sig,, ure(owners fun name) Date(month,day,year)
fib ..../ r 08/18/2014
Fug resident address of applicant(number and street,crty,state,and ZIP code)
404 E Vine Street Ft.Branch,IN 47648
Person authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)