Mortgage_Young Jr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
�� � a County Township Year
*+ FOR DEDUCTION FROM ASSESSED VALUATION
.P• State Form 43709(RI2/6-14) 2016
Prescribed by Department of Local Government Finance MaLLF�Ft-,
u• � LD
INSTRUCTIONS:
To be filled 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 is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the MAR 2 2016
property is located on or before January 5 of the immediately succeeding calendar year. ounty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the ,1❑ ou rder
county where the property is located during the twelve(12)months before March 31 of each year the ,f//(
deduction is t.
o naugh GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Michael Young,Jr. and Emily Young
Tax' Distrigt Key number/legal description 26-18-01-300-002.109-025/1066 W 550 S, Record number Page number
Fort Branch, Indiana 47648 920( 6 /0 6 Yj
Assessed value of real prope 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?
594,751.00 ❑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 r
Address of mortgagee or contract seller(number and street,city, state, and ZIP code) 1 ��� IM�,1trr//, �Q �O
12626 US 41, Evansville, IN 47725 1vlt1J 9 r ' ` V' ed
Name of assignee or other owner or holder of mortgage V `1 I J `_diq 4
Address of assignee(number and street,city,state,and ZIP code) /ir � �' 1 �.lh /U�'tSF/
Does applicant own property in any If yes,what county? What Taxing District? Hi !�- �'V 1 ( I it of
other county on
in Indiana? ❑ Yes ❑ No w..,.„yce'r u res Li 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 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.
Signatu (own s f 1 ame) Date(month,day,ye
Full resident dr s of a scant(number and street,city, state,and ZIP code)
1066 W 0 , Fort r� anch, 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.