HomeMy WebLinkAboutMortgage_Goodman (2)`" ��'° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
i�`'° � FOR DEDUCTION FROM ASSESSED VALUATION
S�� y,� �� S�ate Fortn 43709 (R4 / 70.01)
� Prescribe0 by DeOartment ot Local GovernmeN Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Audifor of the county whe� the property is located. C� Q�$ 2�02
Filing Dafes: 1) Real Property: Dunng the 12 months befo2 May 11 0l the year the deduction is to be effc�cF)v
2) Mobile Homes assessed under IC 6-1.1-7: Behveen January 15 and March 31 0/ year the dedu !'on is to be eflective.
See reverse side (or additional instructions and qualifications. �—��{ /���J-t�%'J
GIBSON COUr� �ip�7pR �
Applicant (owne� or cont ct 6uyer - see restrictions on rev ��side)
,L� �
Taxing Distrid Key n / legal description Record number
��
� e • Page number
\�Jv.�r�.L� _. O � - OO $ � �
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year owneR ❑ Yes ❑ No
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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 of applicant, indicate below: Is the properfy in question:
❑ Real PropeAy ❑ Mobile Home (IC Cr1.1-�
'' •e of mortgagee or contract seller
e
Address of mortgagee or ntrad seller (number and sfieet, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, city, state, ZIP code)
Does appliwnt own property in any other If yes, what county? What Taxing District? Has this dedudion been requested on
county in Indiana? property for wrrent year? � Yes❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
p}
20 p a " 20 D.'� 20 20 20 20 � 20 �_ 0 4
Q. wy � P �
Signature County Auditor Dale
��"Ne certify under the penalty of perjury . e above and foregoing information is true and correct and that the applicants was / were
ident o na and own t o entioned property on March 1, 20
Signat {o rs full na Person authorized by duly executed Power of Aftomey
or by IC 6-1.1-12-.07
sident address of applica � � Address of authorized person
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