HomeMy WebLinkAboutMortgage_Hamm e..^—•'•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
c„._ , " FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R12I6-14) Gibson Ft.Branch
, � Prescribed by Department of Local Government Finance
I L JJ p ) File Mark
INSTRUCTIONS: 11 JJJLLL 11J LLL JJ�
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 ais�sought.
Must be filed or postmarked with the County Auditor or County Recorder of tlfrlbu"p'J-'CUl Ole property is ❑ County Auditor
located 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 t e County Auditor of the county
where the property is located during the twelve(12)months before March 31 of ache tion is sought. '
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) CIDSOt4 COLN I y AU UI I OR
Nathan Hamm
Taxing District Key number/legal description I Record nun r Page number
Ft. Branch 26-19-19-103-000.026-026 a.0 II 11650
Assessed value of 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 March 1,current year date of application legal or equitable owner?
$96,224.00 El Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name an record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
12 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Mortgage
Address of mortgagee or contract seller(number and street,city state,and ZIP coda)
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? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes yyNo 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
Signatur of County Auditor County Date(month.day,year)
'WV t
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 of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month.
day,year))
..ii,>1i _ 10-24-20 ' C
Full resident address of applicant(number and street.city,state,and ZIP code)
1010 S. Center St. Ft. Branch, IN 47648
Person authorized by duly executed Power of Attomey 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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.