HomeMy WebLinkAboutMortgage_Bondaj°�=�, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-a._,.. l FOR DEDUCTION FROM ASSESSED VALUATION
y! 1:� State Form a3709 (RN / 6-09)
jl PrescnbeE by Department of lofal Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail. — — rorm mea wnn:
Filing Dates: 7) Real Property: Musf be compla(ed and dated in the calendar yearlor which the deducfion is soughL1 1 1 Coun Auditor
Must 6e filed with tAe Counry Audifor or County Recorder oI the counry wheie the property is Iocate�Ul . 1� IZ tY
on or 6e/ore January 5 o71he immediately succeeding calentlar year. �❑ County Recorder
2) Mobile /Manufacfured Homes nof assessed as Real Property: Must fi!e with fhe CountyAudifor o7th �
county where the pmperty is located during fhe rtvelve (72) months before March 31 o7each year th�
deduction is sought. C
See reverse side 7or addiUonal instructions and qualifications. OUNTY AU' �
AppGCant (owrrer or cronvad Ouyer - see resnictions on raverse side)
Robin B. Bond
Taring DisVict Key number / legal descnption Recortl number Page numDer
Princeton Township 26-12-18-103-000.628-028 / Lot 1, Blk 1 Baldwin Heights p�Q 3
�value dreal popeM1y as d Mortgage / ConVact indebtedness unpaid as of Mongage / ConVaG indebtedness unpaid as ol Is �he appGwnt Ne sde
.W�tli 1, ament year MarU� 1, wrtent year date of appGCation legal or equitade wmeR
S38,000.00 ❑� Yes ❑ No
If'ro, what is Ns / her exaq s�are of interest? If owned vnN mmeone oNer fhan spouse. inaicate wifh whwn
If name on recorC is tliHerent than lhat of aOW����• ��tlicate below: Is ihe propeM1y in puestbn: MnuaOyASSesseC
Q Real Pmperty ❑ Mnuatly Assessetl
Mabile Home QC fi1.1-7)
Name of mort9a9ee or mnVaa seller
Gertnan American Bancorp
Atltlress of morcgagre or mnVad se0er (numberaM sveet, fifg sfa:e, aM ZlPcode)
PO Box 360, Jasper, IN 47547-0360
Nama of assi9nee or oNer owner or holder af mongage
AOdress of asslgnee (numDer and sLeef. ary, state, antl ZIP cotle)
Does apptiwnt o-xn properry in any other �- If yes, what counry? NTat Taxing Disirid7 Has Nis tleduction been reQUestetl on prope ,ry
county in InCiare? (or wrzent yeaR
❑ Yes ❑ No ❑ Yes ❑ No
�
COUNTYAUDROR
Deduction appmved in Ne amounl of:
20 20 20 _ 20 _ 20 20 _ 20
Syna:ure ot Counry AuOiar Counry Date (mmN, day, yea�
I I We certify under the penalty of perjury [hat the above and foregoing intormation is We and cortect and that the appliwnt is a resident of Indiana and
owner / conVact buyer of lhe aforementioned property on date application is filed.
SgnaNre (owneYS7W me) Date (mmN. C
..L �� 0 2 ���
Fu0 resident aEtlres ol appGCant (numberanC sMaeC dry, 5tate. and ZIP cnae)
1205 S. Washington Ave., Princeton, IN 47670
Person auNonzeE by Cuty ezecuted Pow¢r of Attomey or by IC &1 J42-07 Data (monN. day. yea�
Adtlress of auUwraed persan (numberarrd s•veet, ciry, sta�e, end ZlPcode)
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