HomeMy WebLinkAboutMortgage_Davis (36) 091QF4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Township Year
°� / FOR DEDUCTION FROM ASSESSED VALUATION
f'`'/, State Form 43709(R13/10-15) L 1.~ r �,
'\`ia`1s �''= Prescribed by Department of Local Government Finance ,
INSTRUCTIONS: JUN F Mark '`�
To be filed in person or by mail. 4 3Qiled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county whe flitlte pr., ,ii is.- ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. BSO 4 �7!� . my Recorder
' 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of t ral ,,
where the property is located during the twelve(12)months before March 31 of each year the deduction is salWitY
See reverse side for additional instructions and qualifications. AV0/TnR
Applicant(owner or contract buyer-see restrictions on reverse side)
Davis, Hanna L.
Taxing District Key number/legal description Record number Page nu er
White River 26-04-24-401-000.309-020 cQIO /9P1
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 a,lication v it
(„Il legal or equitable owner?
� J� 9�• UV ❑ Yes ❑ No
If no,what is his I 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
✓❑ Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Fifth Third Bank, National Association, ISAOA .
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Drive MO 1MOBA8 Cincinnati,OH 45227
Name of assignee or ih ner or hol r of mortg
Address of assig e( um r 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 on property for
in Indiana? ❑Yes ❑No 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
i
Signature•7 f tyAupor , County Date(month,day,year)
I/e certify under the penalty of perjury tlat 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.
ature(owner's full name) Date(month,day,year)
ig � .7 5_1 S- ZO 70
Full resident address of applicant(number and street,city,state,and ZIP code)
129 E Cross Street, Patoka, IN 47666
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)
TMe nen,lriec fn.ne.i„n,,.nn innI„'ln irnnricnnrr.nn},rn Fn fe,n nn,J n F,n If ihonre nn'l n firm not in nvr•nnd gin ruin