Mortgage_Siekman (2) .,°-°.o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ii". FOR DEDUCTION FROM ASSESSED VALUATION
6' �� State Form 43709(R73/10-16)
� `' Prescribed by Department of Local Government Finance ��..� I
INSTRUCTIONS: F I� , l File Mark
-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 dfliu(c�b sr) 1?t
Must be filed or postmarked with the County Auditor or County Recorder of the cbt nI €tie j5ioperty is ❑ County 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 Crounty Auditor o unty
where the property is located during the twelve(12)months before March 31 of eac ear ton is sought
See reverse side for additional instructions and qualifications. ATV AUnITOR
Applicant(owner or contract buyer-see restrictions on reverse
Taxing District Key number/legal description Rpe�;ddnnumber/ Page number 1
Barton 26-20-28-200-000.952-001 dJ '1 'U(
Assessed value of real property as of Mortgage/Contract indebtedness 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?
S65,300.00 El 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
Ig 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)
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 a9/ If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county „y-,/ --' on current for ,-„ / -
in Indiana? ❑Yes L�l No cu«ent year? Yes Eli
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 fine 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 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 aforementioned property on date application is filed.
Signe,. a nets full name) Date(month,day,year)
1A ‘______±_ 02/13/2018
Fu esident address of applicant(number and street.city,state,and ZIP code)
SCI 37 r Too S� Bucker,:n 1,s' '-C7 "f 7
Person authorized by duly executed Power of homey or by IC 6-1.1-12-8f, Date(month,day year)
Address of authorized person (number and street city,state,and ZIP code)