Mortgage_French s7,--s,4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
\s�,� ' State Form 43709(R13/10-15)
Prescribed by Department of Local Government Finance Milla r. �3ia is
INSTRUCTIONS: iy �I,.y J iW
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. i7'1
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property isr r EB [ 2]2e48nty Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
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 soug?jt.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON, CuUNl r r.UU?TOR
French, Christopher A. And French, Mindy Lynn
Taxing District Key number/legal description Record number Par
Owensville 26-17-12-204-000.097-022/Pt NE 12-3-12 .26A ao\ss (003 _
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant me sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
98400 79881.95 83740 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 roperty in question:Annually Assessed
Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Ruoff Mortgage Company, Inc.
Address of mortgagee or contract seller(number and street.city,state,and ZIP code)
1110 E Dupont Rd., Ft. Wayne, IN 46825
Name of assignee or other owner or holder of mortgage __ — -
Address of assignee(number and street.dry,state,and ZIP code) '� \` ,� y1 I/ r ' fly 4
Does applicant own property in any If yes,what county? yU\ ��J�pV�(- lJ•.N 1 Ies,state amount of deduction
other county
in Indiana? ❑Yes No
�6 l
A person is not entitled to t 's deduction unless the person h Kr-- Q 03
that is recorded in the county
recorder's office(including any home equity line of credit tha ie deduction.
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 buyer of the aforementioned p •perty on date application is filed.
S'r nature wn
threes full name), Date(month,•.y,ye.
/
Ful resident addre "if a plican number an et,dry, te,and ZIPcode), , L W'-I'
X & i. I S ( eaLW�//ie; /A/ ii (l
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Data(month,day.yeah
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.