HomeMy WebLinkAboutMortgage_McClellan (3) a- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
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State by Department Npppl---111,�,Irrw�j l bn�`p'
i ' Prescribed by Department of Local Government Finance Ap {Atl�.�� f
INSTRUCTIONS:
To be filed in person or by mail. r1 �O;Form filed with:
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sougUE C 30 14
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is i ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. I ounty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor.jJ( comI r
where the is located during the twelve 12 months before March 31 of each 1
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Chris McClellan and Stacy McClellan
Taxing District Key number/legal description Record number Page number
Montgomery 26-17-04-400-001.385-021 /L-S(D0,
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?
/27, Cap . 0€.) E 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
❑ 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)
5050 Kingsley Dr., Cincinnati, OH
Name of assignee or other owner or Colder of mortgage
Address of assignee(number and saver,aty state.and ZIP code)
Does applicant own properly in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other on property for
in Indiana? Yes MNo current year? ❑Yes El 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 I 20 20 20 20 I 20 20
Signature of_ — _"' County I Date(month,day,year)
I/We certify under the pe Ity 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( er's Ml name Date(month,day,year)
( /2\19\ 15
Ful resident address of applicant(number and street,city state,and ZIP code)
9990 W. SR 165, 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,stare,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.