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HomeMy WebLinkAboutMortgage_Lienemann (2) "'"< STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Yearn it _._4 FOR DEDUCTION FROM ASSESSED VALUATION ��('��g ■��-��� \} 40�, l State Form 43709(RIO tment-08) Gibson 1�.10 gom l� ■_J �r Prescribed by Department of Local Government Finance 11 g J+I■���\� • INSTRUCTIONS: File Marls To be filed in person or by mail with the CountyAuditor of the county where the property is located. AUG 05 2013 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 rch 31 of eac e the deduction is sought. See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR_ Applicant(owner or contract buyer-see restrictions on reverse side) Zachary D.Lienemann Taxing District Key number/legal description Record num bqt Pa L/ni u ry rC yMontgomery 26-11-19-400-000.235-021/Pt E 1/2 SE 1/4 19-2-11 o 1 `3 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,moment year date of application legal or equitable owner? 68367.00 © 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 Company Address of mortgagee or contract seller(number and street.city,state,and ZIP code) 5001 Kingsley Drive,Cincinnati,0 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 alcounty in Indiana? ,yM�, for current year? ❑ No l ❑ Yes in No ❑ Yes COUNTY AUDITOR Deduction approved in the amount o` 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 application is filed. Signature(owner's full name t I Date(month.day,year) x7-31 - l3 rest ad applicant(number and street.city,state.and ZIP code) 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)