HomeMy WebLinkAboutMortgage_Lintzenich iM=-4\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township f
i i 11 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) I_
• Prescribed by Department of Local Government Finance _!fl1' ( I AM
INSTRUCTIONS: 1 •,r
To be filed in person or by mail. Form filed with:1
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. MAR A 81051
Must be filed with the County Auditor or County Recorder of the county where the property is located u y Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ Cou ty 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
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Jennifer L.Lintzenich
Taxing District Key number I legal description Record number Page number
Union 126-18-18-100-004.507-021/PT S 1/2 NW 18-3-11 I Pi-511-L.101,1119 I(
II9 /3- DO
Assessed value of real property as of Mortgage I Contrast indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1.wrrent year Mardi 1,current year date of application legal or equitable owner?
168100.00 ❑ Yes ❑ No
If no,what is his/her exact share of interest? It owned with someone other than spouse.indicate with whom
If name on record is different than that of app6cent,indicate below: Is the property in question:Annually Assessed
GI Real Property ❑Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seder
Fifth Third
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
5001 Kingsley Dr MD 1MOCBQ 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 0 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 I contract buyer of the aforementioned property on date application is fled.
Signature(owner'fuff .me) Alp Date(month,day.year)
.1 �. . A.
It • Os ._. 03/18/13
Fut -nt address°V pplieant(number and s -' ity state,and IP code)
6765 S.600 W.Owensville,IN 47665
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)