HomeMy WebLinkAboutMortgage_Archer -STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
S' FOR DEDUCTION FROM ASSESSED VALUATION g
State Form 43709(R13/10-15) G bs m III 2017
Prescribed by Department of Local Government Finance / J
File Mark
INSTRUCTIONS: o c P 1 2 2 i kp rm filed with:
To be filed in n person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be tiled or postmarked with the County Auditor or County Recorder of the county where the pr.•:rty is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year.
I qr l/ ■ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County A@1fagi to ercp{{r1I
where the property is located during the twelve(12)months before March 31 of each year the deduction rs bgtY A DI I OR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Alexander Archer
Taxing District Key number/legal description Re y��j P m .
Somerville 26-20-11-202-000•- 339-003 r111j
Assessed value of real property as of ' Mortgage/Contract ir.3 ebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
100,500 106,940 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
0 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 property in a 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? ❑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 I contract bu er of the aforementioned property on date application is filed. f
Signature(owner's fyr me) Date(mon"1 legal 1 Le
et �?' +I c-Il I
Full resident ad•ress of a••scant(number and street,city,state,and ZIP code)
10467 E Glendale St. Oakland City, IN 47660
Person authorized by duty 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.