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HomeMy WebLinkAboutMortgage_Ward (2) /45,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTED it C,) .1 Township Year a,_ V FOR DEDUCTION FROM ASSESSED VALUATION ti State Form 43709(R12/6-14) `at r .� Ft.Branch 2015 •�-- Prescribed by Department of Local Government Finance LLLI IN DEL- 1'6 Z014 File Mark 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 w/(gjil1ta 's ug Must be filed or postmarked with the County Auditor or County Recorder o f1�L / 's © County Auditor located on or before January 5 of the immediately succeeding calendar year. Na�yy ❑ County Recorder 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Audd4&o f my where the property is located during the twelve(12)months before March 31 of each year the deduction t ught. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Brianna Ward Taxing District Key number/legal description R imher_ ) Pagaweyngey i Ft. Branch 26-18-13-401-000.313-026 Q 'U %J\ (lam(((//1X 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? 114,300 124,699 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 property in question:Annually Assessed p 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 properly 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 No current year? ID 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. Fignature(owner's full name) �G�rl�_-- _ , Date(month,day,year) i,c,S/ /11 /> r,le / l`�`-V 12/12/2014 u0 resident address of applicant(number rid street.city,state,and ZIP code) 514 N. Polk St. Ft. Branch, IN 47648 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,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.