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HomeMy WebLinkAboutMortgage_Moore - "'moo STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year I Ail! FOR DEDUCTION FROM ASSESSED VALUATION ,• � State Form x3709(RIO/11-03) • „, Prescnbed by Department of Local Government Finance Gibson Patoka • INSTRUCTIONS: till Cvf To be fried in person or by mail with the CountyAuditor of the county where the property is located. I��d Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months before March 31 of each year the deduction is sought APR 2 22013 See reverse side for additional instructions and qualifications. l( so Barry L.(owner Moore buyer-see E. Moore on reverse side) '_'—" — 3jjj Barry L. Moore and Carolyn E. Moore Taxing District Key number/legal description : `!1.51r. Vl. I Teiai ti17- Patoka 26-05-30-101-000.226-027ILot G Phase II Benchmark Estates I I s 120241 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole (arch 1.current year March 1.current year date of application legal or equitable owner? I 574,200.00 El Yes ❑ No It no,what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom 11 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 Company Address of mortgagee or contract seller(number and street.city.state.and ZIP code) 5001 Kingsley Dr.Cincinnati,OH 45227 Name of assignee or other owner or holder of mortgage Address of assignee(number and street.city,stare.and ZIP code) Does applicant own property in any other I If yes.what county? What Taxing District? Has this deduction been requested on property county in Indiana? for current year? ❑ Yes ❑ No ❑ Yes El No COUNTY AUDITOR • Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Auditor I County I Date(month,day,year) I IWe 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 I owner/contract buyer of the aforementioned property on date application is filed. Signatut(lowne/s full narppy ^,, Date(month.day.year) . l/\//Oiney�Ct.r7 Iat y �°• Motu_ 04/12/2013 ull resident address of applicant(number and street.city,state.and ZIP code) 2546 Benchmark Dr. Princeton,IN 47670 - Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month.day,year) Address of authorized person (number and street.city.state,and ZIPcode)