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HomeMy WebLinkAboutMortgage_Hurt (5) a s°;as STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County Township Year - FOR DEDUCTION FROM ASSESSED VALUATION a LState Form 43709 Department 14) Gibson F•,j�T ng(i� 2015 • ,-„ Prescribed by Department of Local Government Finance t 7� INSTRUCTIONS: File Ma �9 @..7E�J To be filed in person or by mail. Fbnnipgd with: Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. �U V 7i� Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is © C ng A.1r1Y' 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 the County Auditor of the county Ng where the property is located during the twelve(12)months before March 31 of each year the deduction is Soles See reverse side for additional instructions and qualifications. ON nn,1-0 Applicant(owner or contract buyer-see restrictions on reverse side) f r AUDITOR Jacob M. Hurt Taring District Key number/legal description Rmrd,nuI r P7e n Ft. Branch 26-18-13-101-001.119-026 v/(//�I /�/1 (J Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole Mann 1,current year March 1,current year date of application legal or equitable owner? 112,400 103,098 El Yes ❑ No If no,what is Ns/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 - 171 Real Property ❑ AnnuallyAssessed 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? What Taxing District? Has this deduction been requested If yes,state amount of deduction other county , property for in Indiana? Yes ❑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 owner/contract buyer of the aforementioned property on date application is filed. AiISign tore(owne s full namgl ,s Date(month,day,year) \ 11/3/2014 Full r ident address of applicant(number and street,city,state,and ZIP code) 7 Kennedy Dr. Ft. Branch, IN 47648 Person authorized by duty executed Power of Attomey or by IC 61.1-12-0.7 Date(month,day,year) Address of authorized person (number and street.dry,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.