HomeMy WebLinkAboutMortgage_Deela• "•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
�1 FOR DEDUCTION FROM ASSESSED VALUATION
5��,� S�ate Fwm a3709 (R70/77-0e) Gibson I Patoka
— Presaibed by Deparonent o1 Local Govemmem Finance
INSTRUCT70N5:
File Mark
To be lied in person or 6y mail witA Ne CountyAuditor ol (he counry where [he propeRy is locafed.
Filing Dafes: 1/ Real Property: Must file dunng the year7or which fhe deduction is sought.
2) Mobile /Manulactured Homes not assessed as Real Property: Mus( file dunng [he fweNe (12J monfhs belo�e March 37 0/ each year
!he deduction is sought.
See reverse sitle 1oi addi6onal instrvcfions and qualifications.
Applicant (avrrer a cont2ct buyer- see resLictions on mverse side)
Chrisiopher Deel
Tadng District Key number / legal tlesaiptbn RecorE number Pa e number
Patoka 2612-7 6 7 01-001.728-027ILot 7 in WrighPs Sub. a� i yQ
Assessed vaWe of real property as W Mortgage / ConVact indebtednass unpaid as of Mortgage I ContraG iMebtatlness unpaiG as of Is ihe applirant Ne sola
March 1. curtrnt year March 1, wnent year tlate of apD�wcion legal or equitable owner?
596,123.00 ❑x Yes ❑ No
It no, what is his l her exact share ol interest? If ovme0 vnJ� someona Wher than spouse, inEica:e xiN whom
Ii name on recorE i5 EiF,erent Uan Nat of appliwnC iMicata bebw IS Me properry in pue5ibn: MnuaOy Assessed
❑X Real Property ❑ MnualyASSessed
Mobile Home QC 61.1-7)
Name of mort9aqee or contrac� seller
German American Bancorp �
Atltlress af mwtgagee w mntract se0er (number and s1reeL ciry, sate. arid ZIP cotle)
711 Main St. PO Box 360 Jasper, IN 47547-0360
Name ai assgnee w aNer owner or holder ol rtnrtgage '
Address af assignee (number anE streaf, ciry, state. and ZIP cotle)
Does applicant own property in any olher If yes, what wunry? Whai Taving Disiria7 Has this Eedudm been requesled on pro�
counryinlMiana? ❑ � forartentyeaR � Ye5 No
Yes No
COUNTY AUDITOR
�edu<tlon approveC in Ihe amoum o/:
20 20 20 20 20 20 20
SgnaNre ot Counry AW i:or County Date (monN. day, yea�
I/ We certify under the penalry of perjury that lhe above and (oregoing infortnatlon is [rue and wrtect and that Ihe applicant is a resident of Intliana and
owner I contraci buyer of the aforemenUOned property on date applicalion is (led.
Signature owners7ufl name) � Date (rxnN, day, yee�
10/19I2012
FuA revEent atlEress ot applicant (num0er arAs�reet ciry, sfafe. arM ZIP rotle)
2108 E. SR 64 Princeton, IN 47670
Person auNOnzeO Dy Guly executetl Power of Mwney or by IC 61.142-0] Date (manN, tlay, yeaQ
Adtlress of auUwr¢eE person (numeerand sveet, dry, state. alM ZlPcade)
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