HomeMy WebLinkAboutMortgage_Byers (4)d��o STATEMENT OF MORTGAGE OR CONTRACT IR}C€��� Count Township Year
:;a._.•. � FOR DEDUCTION FROM ASSESSED VALUATI�QI �
�� �� Stale Fwm e3709 (Rt i/ 6-09) - JL � �
�� j Prescnbed by Department of Local Govemmem Finance
INSTRUCTIONS: �UL y S ZO�Z File Mark
To be �led in person or 6y maiL Form sied w�m:
Filing Dates: iJ Real Pmperty: Must 6e completed and dated in the calendar yearlor �7c is sought.
Must 6e filed with the Counry Audiror or Counry Recorder ol fhe county where the e 's located ❑ Counry Auditor
on or be/ore January 5 o/!he immediately succeeding calendar year. ❑ Counry Recorder
2) Mobile /Manu/ac(ured Homes nof assessed as Real Pmperty A(ytggppy'f60C1bWiNitA�FDII6f]f[ the
counry where 7he property is locafed dunng the fweNe (72) months before March 31 o/each year the
tleducfion is soughf.
See reverse sir/e for additional instructions antl qualifications.
Applicant (owner or convact buyer - 5ea restricTiaris m reverse svde)
William W. 8 Zoe Byers
Tawng Disvict Key num0er / legal desuiption R N number Page num
Ft. Branch Township 2E7 &73-402-000.295-026 / Lot 292 Wallace 8 French Add. b� 3$
hcsessed vaWedmal p�ope ,ry as ol Mortgage / GontraU inEeE0.edness unpaid as of Mortgage / Conuact irMebtedness unpaid as a� Is Ne applirant Ne sde
Marrh 1, artent year Ma¢h 1, wrtent year date ol appli�ation legal or equitade owneR
S77,900.00 ❑� �'es ❑ No
I( no, what is nis I her e.act share of interest? If owned with someone o�her ihan spouse, indiwte with.MOm
If name on remrE is tli°erent �han Nat o! apoficant, indicate bebx^ Is the property in question: MnuaDy AssesseE
❑� Real PropeM ❑ Mnually.45sessed
Mobile Home (IC 61.1-7)
Nama of mortgagee or wnNact seller
German American Bancorp
AEtlress of mwtgagce w mnVad seDer (number arW street �Ky: stae, antl ZIP cotle)
PO Box 360, Jasper, IN 47547-0360
Name ot assignee or o:her owner or Fqlder ol rtangage
PAdress of assignee (number anC s:reet. rify, state. antl ZIP code)
�s appGwnt am property in any oNer If yes, whae wunry7 What Taxing Disinct? Has this deductlon been requesteE on pmperty
n in InEiana? for current eaR
ry ❑ Yes ❑� No Y ❑ Yes ❑ No
COUNTYAUDROR
�eduNon approveC in ihe amount oC
20 20 20 20 20 20 20
Synacure ot Counry AWitor Counry Date (rtronN, day. yeah
I/ We cerUfy under the penalry of perjury that the above and (oregoing iniormation is [rue and wrtect and that the applicant is a resident of Indiana and
owner / conVact buyer of the aforementioned property on date application is filed.
Signatu�e (ownefs (ull name) D fl1 »x'��^/
� - / �V�� � LJ�
W �
Fu4 residenl adtlress o appliw^t (^um .E sfraet, ury, slate, i ZIP code)
704 W. Ulen St., Ft. Branch, IN 47648
Person auNOrizatl Oy Euty executM Power ot Attomey or by IC 1.142-0.7 Data (monlh. day. yea�
Address ot author¢eC person (number arW sveef. ciry, slate. antl Z/P code)