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HomeMy WebLinkAboutMortgage_Firkins (3) `^•'a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year rit _ �■ FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R10/11-08) � Prescribed by Department of Local Government Finance INSTRUCTIONS: 1 Fi ; r - 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)mon fofp March 31 of each year the deduction is sought LL .7 c 013 See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) Daniel E.&Jennifer S.Firkins C'IBSON Co())y e Taxing District Key number/legal description Record n m6 it-gri a number Patoka Township 26-11-08-200-000.623-027/Pt SE NE 8-2-11 ao 3 as a R 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? S104,350.00 A[� © Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with Rom If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assesses ©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 Drive, MD: 1MOCBQ,Cincinnati,OH 45227 Name of assignee or other owner or hotter 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 Co 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/We certify under the penalty of perjury that the above and foregoing into ation is true and correct and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned properx on date applicatior filed. Sig r-tore(owner's full nom: r ( Date(mon ardd year) Full -nt addre!of applicant(number and street,city,state,and.IP codel. ' 4652 W SR 64,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) •