HomeMy WebLinkAboutMortgage_Goldbach"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7 i Y r•
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R11 / 609)
.S ,,,, f Presaibed by �epartmeN of Lo�l GavemmerLL Finance D E C
File Mark
wsrRUCnoNS:
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To be fiied in person w by maii wiM the CountyAuditor or Counry Recorder of Me county whe�e the pmperty is located.
Fil'mg Dafes: 1) Real Pmperty: Must file during the year for which the deduction is sought. �,c,,� -
2) Mo6de /Manufactured Hortms rwf assessed as Real Pmperty Must h7e dunng the fweHe (12) months GIB ON � R7 Y R
6efore March 37 oI each year the deduction is mught Counry Reeordu
See reverse side 7a addifiWnal inshvctions arnl qualificatbns.
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Asessed vah�e oFreal poperry az o( Mortgage / Cantrati irdebtedn�s unpaid as of Mortgaqe I Contrad'mde6ledness unpaid as d Is tAe epp&ant Ne sde
Marrh 1, aarerrt yrer March t. curtent yeer Eate o( aPP��� legal or epiritade ameR
� � S�� ❑ Yes ❑ No
If rw. what is his / her exaG share a( interest? If wmed wiN someorre other Ihan spouse. ifMicate wM whom '
If fwrie on �emN a SMerent ihan ihat of appOrant, inCinte belrnr. Is Me property in QuesGOn: MfwaGyPssessed
� Real ProPeKY ❑ ��Y�
� �We Home_QC 61.1-7)
Name ot mortgagee a mntraU seller
a� � G� �u� ��FF r� m,
Mdress M mortgagce w mnvact se0er (number aM streef, ctly, , arM ZIP code) /� O� ���
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Name of assignee w other ownet or hdder of rtpr�gage
AEtlress of assignea (numbei aiM stree; dry, stele, and ZIP cotle)
Does applinnt wm pmperty m any aNer
counryinlndiana? � ..
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a�-Jc�f�00
COUNTYAUDROR
Deduction approved in the amouni of.
20 _ 20 _ 20 20 20 _ 20 _ 20
Sig Camb Audaor Caunry Date pmrth. daY. N�A
I We rtify urW the penalry of "ury that the above and (oregoing infortnalion is We and cortect arM that ihe apD����� � a 25ident of Indana and
owner! contrad yer of e aforemerrti pmperty on date application is filed.
�' Si9�awre (owneh MI Date (month. daY. 3��
ull resiEe add� of appfrant number antl sLee4 G6: ��e, and Z1P mtla)
39�vC. 79S S. Ft. r � I/�I y7(o`IF
P�.,on auUro�rzcE by Gdy executeC Power W Attorney or Cy IC F7.1-12-0.7 Date (monN. day, yea�
Ad�ress of aWiw'ned person (number and sLeet, cil}; state, en0 LP cade) .
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