HomeMy WebLinkAboutMortgage_Blankenberger frra STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count f ° I '
A * FOR DEDUCTION FROM ASSESSED VALUATION Ii
s' State Form 43709(R12/614) Gibson 2015
Prescribed by Department of Local Government Finance .
INSTRUCTIONS: File r ark
To be filed in person or by mail. •rm filed 'th:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. i' ��r>�t;
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is p♦����••J pp itor _
located on or before January 5 of the immediately succeeding calendar year. GIBSO ' )C'dunty ReUcoDrder0
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)
Jeremy Blankenberger
Taxing District Key number/legal description Record number Page number
Ft. Branch 26-18-13-403-000.324-026 144-y(Dl
Assessed value d real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year Mardi 1,current year date of application legal or equitable owner?
105,200 131,020 p 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 propeny in question:Annually Assessed
0 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. 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 If yes,what county? Vital Taxing District? Has this deduction been requested If yes,state amount of deduction
other county „ property for
in Indiana? Yes CI No current year? ❑Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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
own contract b , the aforementioned property on date application is filed.
Signs' r (ow.- s: . ) Date(month,day,year)
/ 2 10/22/2014
F. nt-ddress of a• cant(number and street,city,state,and ZIP code)
S. Welt. Ft. Branch, IN 47648
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,slate,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.