HomeMy WebLinkAboutMortgage_Kerr (2) e,=.'.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
e � FOR DEDUCTION FROM ASSESSED VALUATION
S� - State Form x3709(R11/6.09) Gibson Patoka
� � Prescribed by Department of Local Government Finance
INSTRUCTIONS: F I Fll rlt�
To be filed in person or by mail. Y ^�rA6uPPA�-- 6e
Filing Dates: I) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ��nn'11nn 1 oun Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located FEB 6 l`CA 1 ry
on or before January 5 of the immediately succeeding calendar year. LLJJ ounry Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the /1
deduction is sought. ,(N)
See reverse side for additional instructions and qualifications. SIRSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
David Kerr and Chasity L. Harden-Kerr
Taxing District Key number/legal description iii_0),,_1a_oa 300 000a oze,_oz Record number Pa9Qgwtprusent
Patoka Township :LP_tNE:SW 3-2-iv.— --. -" . -..- -. 201300000855
Assessed value of real property as of Mortgage/Contradi indebtedness unpaid as of— Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
S108,600.00 0 Yes ❑ 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 different than that of applicant,indicate below Is the property in question:Annually Assessed
GI Real Property ❑Annually Assessed
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,arty state.and ZIP code)
5001 Kingsley Drive,MD: 1 MOCBQ,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 other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20_ 20 20_ 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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/contract buyer of ttbe aforementioned property on date application is filed.
Sign i.re(o``e s hill ame) �� �/ _ Date(month yon
Full resident address of applicant�nd reef.aty,state.and ZIP code) �� 2
23 N.275 E.,Princeton,IN 47670
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)