HomeMy WebLinkAboutMortgage_Mraz <•-'w STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSEDS�TIQ�
li,;, State Fom143709(R13/10-15) i Gibson Union 2019
Prescribed by Department of Local Government Finan
ice
10 nnlo File Mark
INSTRUCTIONS: MAY Form filed with:
To be filed in person or by mail
Filing Dates: 1)Real Property:Must be completed and dated in the calendar ear for hic eduction is sought. El County Auditor
Must be filed or postmarked with the County Auditor or he county where the ❑ County Recorder
property is located on or before January 5 of the immedia (I/ggAtiV' rQAar.
2)Mobile/Manufactured Homes not assessed as Rda ITh Q . t de 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)
Joseph E. Mraz , Jessakka M. Schermerhorn
Taxing District Key number/legal description Record nu ber Pa a num er
Union 26-19-19-101-000.540-026 610l'I Is1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
ascessment date,current year assessment date,current year date of application legal oopequitable owner?
$130,200.00 163,400.00 �Xes 0 No
----II no,:what Is hisy 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 thyproperty in question:Annually Assessed
Ireeal Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Dr. MD:IMOBA8, 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 If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? ❑Yes o 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 rr 20 20 20 20 20
Signature of Co ty uditor V �/� County Date(month,day,year)
elk '/J�
I/We certify unde 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 riled.
Signal a(owner's full name) , Date(month,day,year)
04/30/19
Full r dent addre of applicant(n ber and st t,city,state,and ZIP code)
605 E Oak Street, Fo Branch, IN, 47648
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.