HomeMy WebLinkAboutMortgage_Green (4) mn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'-`%A-y_ FOR DEDUCTION FROM ASSESSED VALUATION Gibson Fort Branch 2022
.1,,. -' State Form 43709(R11 6-09) RECEIVED
S .r `r. Prescribed by Department of Local Government Finance
(\ Jw '` JUN 2 7 2022
File Mark
INSTRUCTIONS: 111
To be filed in person or by mail.
Filing Dates: 1.) Real Property: Must be completed and dated in th alendar year for which the deduction is sought. Form filed with:
Must be filed with the County Auditor or County Recorder of the county where the property is located County Auditor
on or before January 5 of the immediately succeeding calendar year.
2.) Mobile/Manufactured Home not assessed as real Property: Must file with the County Auditor of th County Recorder
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)
* Cicily Green I Record Page numberQ
Taxing District n Key number/legal description` �,+ Q / p number2_1— , Z�- l _
�L�j I
*PT SW18-3-10.28ACp --/ l-/O -nQ(- aDD•0 7-adeO
Assessed value of real property as of Mortgage/Contra indebtedness unpaid Mortgage/Contract indebtedness Is the applicant the sole
March 1,current year as of March 1,current year. unpaid as of date of application legal or equitable owner?
'$0.00 *$145,454.00 IIYes 0 No
' $OAO
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with w om
If name on record is different than that of applicant,indicate below: Is the property in question: Annually Assessed
El Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED* Fifth Third Bank,National Association
Address of mortgagee or contract seller(number and street, city,state,and ZIP code)
* 5001 Kingsley Drive, MD:1MOBA8,Cincinnati, OH 45227 JUN 2 g zoza
Name of assignee or other owner or holder of mortgage l , _-/ �/�,
Address of assignee(number and street,city,state,and ZIP code) c'`, OUNTr AUDITOR
CtBSO1What Taxing District? Has this deduction been requested on property
Does applicant own property in any other _ In yes,what county. for current year?
county in Indiana? �^JJ/ 0 Yes 9/No
0 Yes No
COUNTY AUDITOR
Deduction approved in the amount of:
20
20 I 20 l
I I 20 I` 20 I 20 I 20
}�
County \ Date�� 'La_
Signature of County Auditor 0- .r1 (YlS 50`1
I/We certify under the penalty of perjury that the above and foregoing information is and correct and that the applicant i a rest nt of Indiana and
owner/contract buyer of the afore_me/ntioned property on dateda application is filed. Date(month, day,year)
Signature(owners full name)rlj�/� ) ! �v 06/09/2022
bFull resident address of applicant(number and street, city,state,and ZIP code)
* 400 N.Church Street, Fort Branch, IN 47648 I Date(month,day,year)
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7
Address of authorized person(number and street, city, state, and ZIP code)