HomeMy WebLinkAboutMortgage_Barrett (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni 4 - ow Ii S . - Year" !1P
FOR DEDUCTION FROM ASSESSED VALUATION
ix j State Form 43709(R1216-14)
• ' Prescribed by Department of Local Government Finance A
INSTRUCTIONS: AFIiPr�r �17
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 which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property I unty Auditor
located on or before January 5 of the immediately succeeding calendar year. GIBSON COI 1.f}TYcbUrINReRrder
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(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Brett Alan Barrett
Taxing District Key number/legal description Record number Page number
Princeton Township 26-11-12-104-000.572-028 a/O Li 9 Q.
• Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appGCant the sole
March 1.anent year March 1,current year date of application legal or itable owner?
i $J i� 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 Horne(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
Drawer NO.... / * *
Address of assignee(number and street.city,state,and ZIP code) -
Dees applicant own property in any If yes.what county? What Taxing District? Card INTO :duciion
other county ••....
in Indiana? ❑ ...Yes ❑No ••...
A person is not entitled to this deduction unless the person has a balance on the I I /1 Q O .) the county
recorder's office(including any home equity line of credit that is recorded in the county teu',,._. - (1 r CJ
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 aforementio ro erty on date application is filed.
.Signature(owners full name) v-'Date(month,day,year)
— '''' tit— a-a�-l7
Full resident address of applicant(number a sheet,city,state,and ZIP code)
208 3rd Ave, Princeton IN 47670
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.