HomeMy WebLinkAboutMortgage_Luigs?`�Ey�=�4 `- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
��'.'�' '' ' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
s$P�;
z`'•��,y � State Form 43709 (Ri 7/ 6-09) �� g �� 51 2012
�� � Presaibed by Department of Local Govemment Finance �J FIIO MBfk
ieu..
�TRUCTIONS:
befilledinpersono�6ymail. A�� 1 5 2��2
Fifrng Dates: 1) Real Proper}y.� Must be completed antl dated in the calendar year for which the deduclion is sought.
Must be filed wifh the County Autlitor or County Recorder o/ the covat �
on or belo2 January 5 0l the immediatety succeeding calendar year. � Perty is located
2J hlobife / Manulactured Homes not assessed as Real Property�� �Must file with the � Auditor ol the
county whe2 the property is bcated dunng the twelve (72) rfiaFkt�sQ'�t6re y�Q�K 3yl�jj�{tyear �he
deduction is sought.
See reverse side !or additiona� inc�� ��r,..�� e.,a ,....,r.c__,:'_'
D. Luigs
>x�e� �aiue o� reai property as �
arch 1, current year
no, whai is h�s / her exad share o/
name on record is different than thE
ime of mortgagee or conUad seller
:rman American Bancorp
dreu of mortgagee w contraU sell
�[vlain Sheet, P.O. Box 360
of assignee or oNer owner or h
see resfictions on reverse
Key number � �ega� description 26-19-18-304-000.476-026 / Property
CiVrlreo�
E Vine Street Fort Branch, Indiana 47648
26-19-18-304-000.476-026
Form filed with:
� County Auditor
� County Recorder
number
1 a � y33�
�- ����euness unpaia as m Mor�qage / ConVact indebtedness unpaid as of Is the applicant [he sole
March 1, wrtent year Oate of aOPliwtion legal or eQuitable owneR
590,816.00
� Yes ❑ No
It owned with someone other than spouse, indicate with whom
ll. - _
- Is the property in ques6on: Annualty Assessed
_ ���s/ �1„n��� �RealProperty ❑AnnuailyAssessed
��� Mobile Home (IC 6-1.1-7)
DI'a�y� \`0..��(�,
�
w Card \'O. ....�!�3�.......
°°` �►96,gi�. _
�
�� appncam own properry in any ol�er If yes, w�at c
ry in Indiana?
❑ Yes � No
dion approved in the amount oL
20 _ 20 _ 20
I/ We certify under per alty of
ovmer / coniract buyer o( the �
E Vine Street, Fort Branch, IN 4764g
m aufhorized by tluty executed Power of Ann
person
20 _ � 20
nas �ms oeauc6on been requestetl on
for wrrent year?
� Yes
20 _ 20
yea�
the above and foregoing iniormation is true and corred and that the applicant is a resident of Indiana and
ied property on date application is filed.
or