HomeMy WebLinkAboutMortgage_Hisch ^yl,v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ll,/_ �4 FOR DEDUCTION FROM ASSESSED VALUATION 2017
�.C� , State Form 43709(R12 1 6-14)
\ Je Prescribed by Department of Local Government Finance File Mark
FILED
INSTRUCTIONS:
To be filled in person or by mail. .J 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 couq�,�yl�nth2,
property is located on or before January 5 of the immediately succeeding calendar N 1-1 COl l County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the CountyAuditor of the ❑ County Recorder
county where the property is located during the twelve(12)months before March 3 f each y art - -
deduction is sought.
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Stephen W. Hisch
Taxing District Key number/legal description 26-23-06-300-000.118-009/426 S West St. Record number Page number
Haubstadt, Indiana 47639
26-23-06-300-000.118-009 I q— 153
26-23-06-300-000.770-009
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?
$151,200.00 1V/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 6tsessed
Mobile�Hone(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 Drive, 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 District? Has this deduction been requested If yes,state amount of
other county on property for deduction
in Indiana? ❑ Yes No current year? ❑ Yes ❑ No
A person is not entitled to this beduction 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
S'i nature' oun Au•itor �l,/
/ Z JJ ` ounty I Date(month,day, a r)
Cr.certify under penalty of perjury that the" •• 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.
nature(own am7 ,(/ 2 ?lie(month,day,year)
ull resident a dress of applicant(number an street,city,state,and ZIP code) l
426 S West St., Haubstadt, IN 47639
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)