HomeMy WebLinkAboutMortgage_Goodwin"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun nshi vear
_,_ • FOR DEDUCTION FROM ASSESSED VALUATION
� Sta[e Form 43709 (R17 / fi09)
�,w � Presvibed by DepartmeM af Laal GovemrtrerLL Fnarcx
ile Mark
iNSrnucnoNS:
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To 6e ned in person or by mail with the CqunryAudita or County Recorder o( the county where Ihe property is located.
Frfing Dates: 7J Real Property: Must file d�ring Ne }rear /o� which tha deducLOn is soughf. County Auditor
2) Mo6de / ManWactured Homes rrot assessed as Real Property: Mus! file during the fweNe (72J months �
before March 31 0/ each year the ded�xtion is sotght. �Rec°�du
GIBSO
Sea reverse side � addrtional insLUCtions arM quali�ications. AUDITOR
AooGCanl (owncr �trzU buver - see verse sidel, �
Asse�eC v
Marth 1, a
u iw. wnat
It narrre m
f rndl property as
ymr
Wan
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Mo�qage / Contract'ude6tedn�s unpaid
Mamh 1, wrtenl yeer
�
L Ndifate Eebw
Name of mortgagee or contract seller �//
r�
Address W mortga9eE w mntraa seAer (number er
Name of assignee ot other ownet or hdder W mort�
AOdmss of as9gnee (numbe� aM street �Y. s+eM,
ciy, SfetB, aml ZIP coda)
�
/.� �-� / g
Reco(d number Page number
G <5
unpaid as M Is Ihe app(xant Na sc
kqal a eguilaNe ovm
Yes LI No
Is ihe property in Question: Mnuelly As5e55eA
�Real Properry ❑ Armually Assessed
Mobile Hortie (IC fi1.
Does appfiraM axn property in any oNer If yes, what munt/� 'ed m propeny
munry in Indiana?
❑ Yes ❑ No O , ...... •¢� ❑ N�
lll':11�'CC \�.... . ... •
couNn �
DeLUClion aPW� in ihe amount of. J .......
C,�t.a \�, ...�.�RS....
zo_ zo zo_ 20_ � ����0(SL.�`b m_
SignaMe W CountY Auditw Caunry Date (month. eaY Y�A
I I We certify under the penaly o( perjury Ihat Ne above and foregoing infwmalion is true and correct arM that ihe applipnt is a resident of Indiana arW
owner I contrad buyer of the atorem " ed prope on date applicalion is filed.
srer�mr�mwners rw r�,rre� oa� �,r�m, ear raen
Full �eddem a0tlress W appfrcant (lhm+be�antl ary, stere a� Z/P cd
3990 �U r� s w �, -�o k� ,
Person autlrorrzed Gy duty esecuted Power af Attaney or by IC Fi.1-12�.7
Pddress of auNortred person (number arid sLee( ciry. sfale. aM ZIP cotle)
Date (rtronN, daY. Y��