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HomeMy WebLinkAboutMortgage_Reneer • a,,-'�\ STATEMENT OF MORTGAGE OR CONTRACT INDEBTE S t lit Township I Year I /-a4 FOR DEDUCTION FROM ASSESSED VALUATION • • State Form 43709(R10/11-08) Gibson Patoka �' � Prescribed by Department of Local Government Finance - gr119 AP 2'6 L111J INSTRUCTIONS: File Mark To be filed in person or by mail with the County Auditor of the county where the property is located. di; Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. , —41n7711. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the Eve•• - • {� . q�3®1ITIO 31 of each year the deduction is sought. GIBSON See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Harold W.Reneer,Jr.and S$hanie A.Reneer Taxing District Key number/legal description Record number PageThpttfu0lEnt Patoka 26-05-32-1006-000.025-027/A S Pt of the NW Qtr.of Fractional Sec.32 201300002165 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1.anent year March 1,current year date of application legal or equitable owner? 5159,700.00 © 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 ©Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Fifth Third Mortgage Address of mortgagee or contract seller(number and sheet.city,sate,and ZIP code) 5001 Kingsley Dr.Cincinnati,OH 45227 Name of assignee or other owner or holder of mortgage Address of assignee(number and sheet-city sate,and ZIP code) Does applicant own property in any other If yes,what county? rat Taxing District? Has this deduction been requested on property county in Indiana? for current year? ❑ ❑ ❑ Yes Yes No ❑ 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 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. Signal e wner's lull Date(month,day year) 04/19/2013 F resident address of applicant(number and .city,state,and ZIP code) 712 E 200 N.Princeton, IN 47670 Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street,city,sate.and ZIP code)