HomeMy WebLinkAboutMortgage_Gooch"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� �- • Slate Form 437 � R11 6�J)
I STRUCT10N3.'�� �� J� �� � File Mark
To be filed in person w 6y mad with tf(e�L� n A1(ditor or Counry Recorder o7 the caunry where the pioperty is located. F� �� ��'
Fili� Dates: 1) Real Property: MushlileYlun� $ie���r which the deduction is soughL � Counry Auditor
2) Ab6�ie / Manufaclured Homes rrot asseued as Real Property Mus! file d�nrg the hveHe (12) months
6efore March 31 oLEach year the dveduction is sought. ❑ Counry Recorder
See reversa sido-(or addilional insWC�s and�WS�ations. n
Tarirg Distriq
ed ra4e d real poperty as of
1. arreN ypar
tt ra, what Ls h's l hu e�1 share of interev?
/ Contract irde6ledness unpaid as ot
rama m �ewN o Gilfereni Nan ihat o( aPC��4 �ipte Gelrnr.
of rtarigagee w mntracc seAer
Name oi assignee w oNer owner or holEer of rtpngaga
cdy. smte. aM LP code)
AOEress of assi9nee (numDer aM seee4 d+Y. s+ate. entl LP cade)
DJES BPWItlN OWfI V�VQnY N 3(1Y ONC!
6�If1Iy I!1 �fld0fld) 11 _ _
unpaid as W
smneone other tlian spouse.
IS CM p1OpClIy ifl QIlCSUO
❑ Real Property ❑
r epuitade ameR
❑ Yes ❑ No
/Nf1U2�'ASSCSSE�
�i25 U15 dC4UC110f1 tCGll lCQUMIP� Of1 p(OpPlIY
fN 411RCfR yC2i� ❑ Y�
❑ No
COUNTV AUDITOR
Deduction approveE In �he amount oE
20 _ 20 _ 20 _ 20 _ 20 20 _ TO
Sig�awre d CaumY Aueimr Counry Date (monM. OaY. Y��)
I/ We ceNfy under �he penalry of pe�ury that Ihe above aM foregoing informalion is We and cortect and Nat Ne apPlipnt is a resident of irdiana aM
owner I contrac� buyer of the aforeme(rtioned property on date appiication is filed.
Sig h hAre Da@ (nmfi. daY. Y��
F II � ent aCtlmss o( a aant um6e� and sheef, ri te, and ZIP code)
�ia�� s Oi S+A .�s
authorized Oy duy ezewted Power of Attorney or Ey IC 61.1-12-0.7 Date (monN, dey, yea�
Pdtl�¢s of a Wior¢rd person (numbe� arM sbeeG ury. slate. antl LP code) .