HomeMy WebLinkAboutMortgage_Jaymes (2) e•— o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
< Slate Form 43769(R13/10-15)
Prescribed by Department of Local Government Finance L _
INSTRUCTIONS:
File Mark
To be filed in person or by mail. A P Fqr I
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 1 i1 LU 17
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. .0 Co der
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the count
where the property is located during the twelve(12)months before March 31 of each year the deductioG' COUNTY See reverse side for additional instructions and qualifications. AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
Starkey, Jaymes N.
Taxing District Key number I legal description Recor ber Pa Aber
Patoka 26-12-16-100-002.224-027/PT NE 16-2-10 1AC 8 PT NW 15-2-10 1.14AC '� number
Assessed value of real property as of Mortgage I 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 quilable owner?
88200 0 100000 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other Nan spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
ASKal Property ❑ Annually Assessed
I 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)
5001 Kingsley Dr., 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 deduction
other county ,�L_.Jj(�7�!0 on property for
in Indiana? ❑Yes - 1 current year? ❑Yes ❑No
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 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 20
Sign to itw �jt\ ( County Date(month,tla year)
tf5rVe Li
I W under the penalty of perjury that the above and fore oing ,information is true and correct and that the applicant is a resident of Indrana and
owne /contract buyer of the aforementioned property on date application is filed.
K"(Lure o met's full n me) D e(month,day,year)
. ../t,' - CoH1II/ 2oitr
Full residetaaadre�s f pplicant(number and street.city,state,and ZIP code) /� I .I
Xd.i Vitt Cot, fr- 4, t 02 T'r:nr,tcn rAJ / 76,7D
Person authorized by'huhy executed Power of Attomey or by IC 6-1.1 2-0 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 S10,000.