HomeMy WebLinkAboutMortgage_Goodman^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ , FOR DEDUCTION FROM ASSESSED VALUATION
Slata Fortn 43709 (R11 / 6-09)
�' , Presaibetl by Departmant ol LoCel Goremment Fr¢nce
�W File Mark
�VSTRUCT/ONS: N
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fo be filed in person or by mail with lhe CauntyAuditor or Counry Reaorder of Ne county whe2 lhe pmperty is la:ated.
Fil'mg Dates: 1) Real Pmperty: Must file durrng the year /or which the tleduclion is soaghL .� r�u�ry q�diwr
2J Mo6Ae / Manufactured Homes rwf assessed as Real Pmperty: Must file durirg the fweNe (72) months —�C'"`"'\" �
before Ma2h 37 of each year the deducfion is sought. ❑�GaYt� Recader
See reverse side (w additronal insWCtions arM qualfications. � G I BSO
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Abrtgage / Contraa uWebteA�ress unPaiO as W MoriBa9e / Contra`Y mEe6tedness
MaTh 1. Curte�rt year date ot appGUtion
ts his / her eYae shara of intuest7
If rame an �emrE a EiRe2n11han Nat of appl"iwtl, i�Mifate bebw:
Name of rtnrtgagee m m�tract seller
Mdress o( rtnrt9a9ee a
ciry, stste,
I numbu Page wmCrs
az of Is Ne appfxan Ihe sde
kgal a W�Uade awnYl
❑ Yes ❑ No
If wmad xith someorre otlrer �han spaise. IMipte with wlwm
Is Me PmCertY in 9uestion: MnuellY ASSe55ed
❑ Real F'roPe�ty ❑ MnuallyASSesSed
Mo6ile Hane (IC 6
Wme of assi�ee w aNa wmer w holder of �mtgage -�. .
�_' _ ' ' _ _ _ _
AdC�ess ot assayiee (num6er and street �Y. slafe. an ��D D�� �F'Fj'� �
Ooes a�plitant own pmDP+�Y in any aher ►{� r/�ry� 6 �s iha detluflim Eeen 2pueste0 m G�W�Y
counry in IMana? n Vx n No I 1/� l.i I� : aerent YraR ❑ Y25 ❑ I
DeEuUOn apprweE in Na amoun
20 20
SignaMe W Cowiry M�ditor
� I - ��31
2Q 20 20
Caunry
2(1 � 20
I/ We certify under Ne penalry of perjury Nat Ne above and foregoing in(ortnalion is W e and cortec[ aM that the appli�ant is a resident of Indiaria aM
owner I contracl buyer of Ne aforementioned property on date apPl'ication is filed.
7�uw� (ownerY hd/�ame) /� � I Date (rmiri�. EaY. Yee�)
)� � t'
�Y
Pdtl� of authorrzetl persm (num6ef aM street mY. stafe. and ZlPmde)
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