HomeMy WebLinkAboutMortgage_Higdon STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
"Tr FOR DEDUCTION FROM ASSESSED VALUATION ,I^�
.- ass Form (R13/tbt5) �i(J ��
‘"-1, Presrn by bed Department of L I Government Financel
W Fie Mark
INSTRUCTIONS: .
To be filed in person or by mat Fonts tied.trt
Fang Dates:1)Real Progeny:Must be completed and dated in the calendar year for which the deduction is sought
Must be fled orposunarkad with the County Auditor or County Reorder of the carry when the progeny is ❑ County Audlor
busted on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2)Mode y Mersa-matured Homes not assessed as Reel Property.Must the with the County Auceor of the county
where the progeny is located during the Metre(12)nmNs bebre March 31 of each year the deduction is sought
See reverse side for additional uustuclioru and qualifications.
Apperant(omen or muse lug-sea raeirinv on raters.me)
Sarah Higdon,David Higdon
Tasty Oi!ict Key number/legal eaafp%on Rcaytptim I r I Pa number,i
Haubstadt 26-19.31.303-000.142-009 „(3 3
Assessedvale of real weeny asol LsorVage l Caned Indebtedness wpm as of Mortgage/Contract bdeaednesa woad as of b then Ole sob
assasuram oa,one year onto, a fah,oarentyear data of eppfaton legal '.talx'e Ou:eR
95,200.00 77,000.00 Yes U No
It no,what is his/her east daze of ttlesesn Ill anted rAN eanewwlf76a'jpa ID1
a name on reach is 6terant sun tut of apt/tars beefs below: }s l��0rMAssessed
J iAssessed
Mobile Home(IC 67 1-7)
Name d mortgagee drmarm sties SEP 04 20)8
Fifth Third Mortgage Company
Marra of mortgagee or contract sees(number and net city,State,and ZIP ode)
5001 Kingsley Dr. MD:1 MOBAS,Cincinnati,OH 45227 _ n d 7!
Na-xd uPawa drCYC ownesa MMerdnmpage V ILl
n n r
Address of assignee(number and net city.state.and ZIP code) •• •• , '�sa
Does applicant owl progeny n y C yes,Met cW.:yl that Tally Utica Hessp cis
crleeydu6cn teen segues-ad It yes,state wooers cf eedr#bt
it itt,a,at� ❑Yes No avttmtyeea? Oyes Duo
A person is not naiad to this deduction unless the person has a balance on the person's mortgage or convect indebtedness that is recorded N the county
recorders oft (inducting any home equity lure ofwadit that is'acceded in the county recorders mice)that is the basis for the deduction.
COUNTY AUDITOR
Delusion apvroveC In Me amount et
20 20_ 20 20 20 20_ 20
Signature of County Audio( County Data(month day,leaf)
I/We certify under the penalty of perjury that the above and foregoing i nfomlation is true and cones and that the applicant Is a resident of Indiana and
r/contra°buyer of the aforementioned property on date apprnation is tied.
Da(mon'Jt,clay,yew)
ee((A , /
�ft 07(02/16
Fop,eskm amressda m( NW Meet ay,state,and
IP )
305 W, Haub Street, Haubtstadt,IN,47639
Person autadzed by drily executed Poet at Money or by IC 6-1.1-12-0.1 Date(neon day.year)
Address eta JI°Ired person(numbet and meat city,Pate.and ZIP code)
The penalties for penury can include imprisonment up to two end a hat years and a fine not to exceed S10000.