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HomeMy WebLinkAboutMortgage_Emerson y."%a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun I Township Year f I FOR DEDUCTION FROM ASSESSED VALUATION et:- State Fo 43709(RIO/11-08) Gibson Montgomery rm Prescribed by Department of Local Government Finance INSTRUCTIONS: •a1 -:© To be filed in person or by mail with the CountyAuditor 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)montfijifog&Iti3 r of each year the deduction is sought See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) stt` - Quentin B. Emerson GIBSON COUNTY AUDITOR Taxing Distract Key number/legal description Record number Poe nuy+ Montgomery 26-17-11-200-000.540-021/NW 1/411-3-12 ant 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? 94,100.00 © 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 ❑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,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 © 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 un•nr 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 con y�of lb foreme r' ed property on date ap ' anon is filed. Signature(• �1 I Date(month.day,year) ' 07/16/2013 Full resident. sofa•• • - t(numbe and street,city state,and ZIP code) 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)