HomeMy WebLinkAboutMortgage_Goodman (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
1 ,.
- FOR DEDUCTION FROM ASSESSED VALUA�� ��
� � State Fwm 43709 (R11 / 609)
� Presvibetl by Department af Lool Govemment Finance
� File Mark
�NSTRUCTIONS: SEP 6 2012
To be filed in persan or by mai/ with the CountyAudimr or County Recorder of the county wAere the pioperty is located.
Fding Dates: 1) Real Pmparty Must file during Ne yea� (or which Ihe deduction is sough .
2) Mo6de /Manufactured Homes rrot assessed as Real Pruperty: Must � dt nng t eTvq (12) months
6e/ore March 31 of each year Ne Ceduction is sought. V�� �
Seereverseside/oradditionalinstnictionsandqualifications. GIBSONCOUNTYAUDITOR
Appfec�pf (ownerw oontrarl buyer � 25Uir�l.brss m myer�e v0e) . .
If ro, what Is his / tcer eza� shara of intemst? --
tt`wre m`ecad is Nfierent lhan ihat ol app6�ni, 6d'uate belaw.
Name of mwtgagee or contract seller
/$�
mort9a9ee or mntracl seller
otner owner or naaer m mortgage
state.
qaarew ot am9�e (numcer am suee� cuy. s�e. am ur 000e�
Dces eDWipn[ wm pfopeM1y in any oNer I If yes,
munry in Inda�a? n., n.
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Form filed with:
�CounryAuditnr
County Recorder
Retordruun0er
Is Ne appGrant Na sale
legal w equitade mmeY/
❑ Yes ❑ No
H owneE wiM someo� oiher Nan spwsa. "uMkate wBh whom
W�at
Is tl�e OmPertY in Question: MnuaDy Assessed
� ft221 PfoPeKY ❑ ?����Y.�
Dra�ver !\'0..��
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Card \'p, , � �a .
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COUNTYAUDROR
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Counry
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Da�e (monM. daY. Yea�
P�Y
� No
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I/ We certify unAer ihe penalry of perjury that the above and toregoing infortnation is W e and cortea arM that the applinnt is a resitlent of IrMiana a�
owner / conVact buyer of Ihe aforementioned property on date applicatlon is filed.
1 (owne/5 h$lame) I D2te (mOnth, daY• Y��
`��`{Gy, w.id �
Pelsm auNo�aed Dy OWy executed
sLee4 �1; �te, arM LP catle)
ro�l RO oWeN.s��•�
�itamy or by IC 67.1-12-07
perv�.,on (numDer aiM sbee4 �y. sbtc.
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