HomeMy WebLinkAboutMortgage_Guisewite Sa n, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ijI�'I� au, i Year
4 FOR DEDUCTION FROM ASSESSED VALUATION - =— •,a' or
i '
State Form 43709(R72/614) Gibson Union
,r„ J Prescribed by Department of Local Government Finance i U G 16 2016
File Mark
INSTRUCTIONS:
To be tiled in person or by mail. A- Fo •fit-. ith'
Filing Dates: 1) Real Property Must be completed and dated in the calendar year for which the deduction is sought. I -rws l)
Must be filed or postmarked with the County Auditor or County Recorder of the county where the prwerty i• ty r�Auditor
located on or before January 5 of the immediately succeeding calendar year. Li I B SO N CO KYC�1I'1ry 1TTe lr er
2) Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the county
where the property is located during the twelve 02)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner a contract buyer-see restrictions on reverse side)
Amanda M. Guisewite and Hope C. Allen
Taxing District Key number/legal description Rgcofd- ( P era 26-19-18-303-000.891-026 �2t`�J
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applCan the sole
March 1.current year March 1.current year date of application legal or equitable owner?
$141,391.00 171 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 Acx ssed
IZI 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 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 Distract? Has this deduction been requested If yes,state amount of deduction
other county , property for
in Indiana? 1_1 D 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 Data(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 I contract buyer of the aforementioned property on date application is filed.
gnature(y»ne+s lull n e) II 1 Al /� Date(month.day.year)
Il l\I L 'IT1 (`, 08.year) 16
Full resident address of applicant(number and street,dry,state,a ZIP code)
401 E. Locust St. Ft. Branch, IN 47648
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Data(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 510.000.