HomeMy WebLinkAboutMortgage_Russell (2) �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°i FOR DEDUCTION FROM ASSESSED VALUATION
i� State Form 43709(RI 3/10-15) �� ibson White River Township 2019
4 >• Prescribed by Department of Local Government Finance .c1 i(
INSTRUCTIONS: p1[i�� }q�- File Mark
To be filed in person or by mail. �f�p Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which,(I(q dr f4tidJIH Sought.
Must be filed or postmarked with the County Auditor or County Recorder of o n y where the property is 0 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 t e Coun 1 a,.r of the county
where the property is located during the twelve(12)months before March 31 ., :a�lf ,c16 . d r i4gyEtsought.
See reverse side for additional instructions and qualifications. COt 114TY P
Applicant(owner or contract buyer-see restrictions on reverse side) GABS°N
Jeffery& Marcia E Russell
Taxing District Key number/legal description Record number Page number 1 `
White River Twnshp 26-05-58-026-000.751-018 2 o� + Z�=f `1
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?
$142,000 ❑l Yes 0 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 d erent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑ Real Property ❑ Annually Assessed
/� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /r/iSde-// _ ff U.c
Fifth Third Bank , 1 5y
Address of mortgagee or contract seller(number and stn rn.A flat(. G
Name of assignee or other owner or holder of mortgage 7// f H ri, r.e.- a AN,
Address of assignee(number and street,city,state,ano 41/ / 7 CCU, r2
Does applicant own property in any If yes,what coun.,. been requested If yes,state amount of deduction
other cou n ndiaana? ❑Yes •No I I current year? 0 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 recorders 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)
AWL ( IT"-I-/., A- Gibson 7/17/2019
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 property on date application is filed.
Signature(owners full name) Date(month,day,year)
,//1,009' 07/17/2019
Full resident address of applicant(number and street,city,state,and ZIP code)
5670 N 75 E, Patoka, IN 47666
Person authorized by duty 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.
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of applicant Name of mortgagee or contract seller
Jeffery& Marcia E Russell Fifth Third Bank
Date filed(month,day,year) Amount of indebtedness Taxing District
07/17/19 $142,000 White River Township
Key number I legal description
26-05-58-026-000.751-018
Signature of County Auditor I County Recorder County Date(month,day,year)
Gibson 07/17/2019