HomeMy WebLinkAboutMortgage_Goodman�° STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
' ' FOR DEDUCTION FROM ASSESSED VALUATION C ar
� State Form 43709 (R4 ! 70-01)
w, �� Subject to inal acceptance fo trensfer
� Prescribed Uy Oepartmenl ol Local Govemment Finance �� _ day ( _
i�
� Auditor
INSTRUCTIONS: � Fi
To be filed in person or by mail with the County Auditor o/ the county whe2 the praperty is located. � �+�n County
Filrng Dates: 1) Real PropeRy: Dunng fhe 12 monfhs belo�e May 11 of the year the deduction is to ������R
2) Mo6ile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 of the year the deduction is to be ef/ective.
See reverse side tor additional instructions and qualifica6ons.
Appticant er rconhactbuyer-see trictions nreve side)
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Taxing Di Key number / legal descriplion Record number �� �
' fy� /j_ � /�� �� O Page number �
Lit/ /
Assessed value of real property as of MoAgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitabie
March 1, current year March 1, curtent year owne(t � Yes ❑ No
( i(J
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 ot applicant, indicate below: Js the_oro�nr.rtv.�n ���o�r�,..._
�\�S F.°`�J /�,� i1.1-
�ameofmortgageeorconVadseller Drawer�NO..�W�•••••••• �
Address of mortgagee or conirad seller (number and street, city, state, ZIP Card NO. a S Y°�
.....................
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Name of assignee or other owner or holder of mortgage
Address of assignee (number and sheet, city, state, ZIP code)
Dces appliqnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for current yeaR� Yes� No
COUNTY AUDITOR
Deduction approved in the amouni of:
zo Q� 2o O 20 � zo zo �� zo � zo 0 9
� � P P P
Signature County Auditor Date
/ We ceAify under the penalty of perjury lhat the above and foregoing infortnation is true and corred and that the appiicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
Signature (ownels full name) Person authorized by duly exewted Power of Attomey
� � �! or by IC 6-1.1-12-.07
Full re ident address of applipnt Address of authorized person
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