HomeMy WebLinkAboutMortgage_Goldbach"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
__ . FOR DEDUCTION FROM ASSESSED VALUATION
� Stale Fwm 93709 (R71 / 6-09)
4' ReuriCed Dy DepartmeM of Laml Gwemmerit Finarxe
w.
�STRUCTIONS: EL mn
To be Red in person or by mail wifh the CounryAUditw or Counry Recorder o! Ne counry where the property is bcated. � � �7 �C � ��
Fifing Dates: 7) Real PmpeRy Must file dunrg the year for which tha deduUion is soughl. County Audimr
2J Mobde / Manulacfured Homes rat assessed as Real Pruperty: Must ne dunng the fwefve (12) months C �.
befae Ma2h 37 of each year Ne deduclion is sought. u Reoorder
See reverse side for additional insUUCtions and qualificahms.
MP��t (owrrer w cmfrdU buyer ,�sepfestrirfia�.t w rcverse sife) . I�
�an u , ney ewwrt�celi regai acsaipoon nw��a rwmue� rayc u+��
a� -ia-��-a,00�000.� s8-oa8 �3 y
q� veqre of real qopMy as d MortgaBe / Contract irde6tedness unpaid az of Mwl9age / Contrac['vi0ebteAness unpaid as of Is Ihe appl'ipnt ihe sde
Mamh 1. �vmrt year Mamh 1. wrtent ynar T date of appG2lion legal or equitade ox�eYt
� O LJ ❑ Yes ❑ No
If no, what is his / her e� shara o/ interest? If owned with someone otlrer than spouse, i�ttate wiM whom
It name m �ecdd is tliRe2nt ihan Nat al applkant i�Micate bebw. Is ihe property in pueSUOn: Mnually Asessed
CT�jfx� a�nv ❑ a,�,u�ya�
.. AAodle Fiortie fIC 61.L7
Name of macga9ee or mntract
ndaress m � «m„o-aa
city. stae. aM ZIP cade)
Name ot assiryiee a ather owner w hdder of morigage
Pd725s of assi�ee (n r sheet �'. sbfe, and ZIP code)
N[G �s 76 �
Dces applzant wm property in any oNer I( yes, what munl7R �M�at Ta.
munry in InEiana? ❑ Yes
❑ Na
couNn nuoRo
Dedumon aowa.ed in �he amount of:
D►•a�t�cr NO.....��..��
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Card NO. .:..y�3�......
� � li � �� : c�u
20 20 20 20 _ 20 20 20 _
u�ature W CamN AuEitor ' Counry Da1e (monN. tlaY. Yza�
C•
I/ We certify under the penalty of ury ihat the a arW foreqoing intormalion is We and correU arM that the applit�nt is a resident of Irdiana aM
owner I contracl buyer of the afotementioned prope on date applinlion is filed.
�n�nu� (owners hd ^eTa) _/l. / Date (rtmrh, daY. Yaar)
FW resident aCCr¢� o( appfrant (num6ei and sheei. tlry, sYdte. and Z!P cotle)
7O i W� ISOF% /{-✓2- %�/��NLe{anJ
Psmn auNwrseO Ey tlWy erecuted Power d AttameY � bY IC Gt.1-12-0.7
fdtlrew of aWwREA pusm (number ana sLee; riry, stale, and LP fntle)
oa� �rro�vn. var, r�