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HomeMy WebLinkAboutMortgage_Lewis (2) i. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County/__ FOR DEDUCTION FROM ASSESSED VALUATION �4D �� _ 4 �i, State Form 43709(R10/11-08) Prescribed by Department of Local Government Finance un n 1 1 2 INSTRUCTIONS: FiiA MIK 2 2014 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. n' 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months before Mardl183ni9t the deduction is sought. GIBSO//NM����'C"ODUNN'TYYr"AUDITOR See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-see restrictions on reverse side) . Jessica J.Lewis Taxing District Key number/legal description Record number Page number Patoka Township 26-11-26-300-001.114-027 QQ (M (0(1 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? 75,800.00 0 76,530.00 © 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 Ascs sed p 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 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 under the penalty of perjury that the above and foregoing information is we and correct and that the applicant is a resident of Indiana and owner/contract buyer of the aforementioned property on date application is filed. Signet a(owner's full name) (� . Date(month,day,year) 9 � �7 g/A./to 03/07/14 FS r dent address of appl' (number and street,city,state,and ZIP code) 2225 W.400 South, 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)