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HomeMy WebLinkAboutMortgage_Bingham STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I To ship I Year I FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R10/11-08) i n � Prescribed by Department of Local Government Finance INSTRUCTIONS: MAY 22611math To be filed in person or by mail with the County Auditor of the county where the property is located. 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)m s be 1 of each year the deduction is sought. �IQIk See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR Applicant(owner or contract buyer-see restrictions on reverse side) William M.Bingham and Johnna Bingham Taxing District Key number/legal desuiption Record number Pa number Patoka 26-12-09-104-000-818-027/A S Pt of the SE Qtr of the NW Ott'of Sec 9 I ,91013 0 3 5 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.current year March 1.current year date of application legal or equitable owner? 5107,000.00 © Yes ❑ No It 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 El 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 street,city,state,end 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,slate,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 inlndiana? 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/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 the aforementioned property on date applion i filed, �ig (ownef ull na r Date(month.day,year) 'r�j�' 04/24/2013 resident address o applicant(nu and street.city,slate,and ZIP code) 1772 Outer Lake Rd.Princeton, IN 47670 • Person authorized by duty 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)