HomeMy WebLinkAboutMortgage_Slater.+"-�, STATEMENT OF MORTGAGE OR CONTRACT INDE
-i� FOR DEDUCTION FROM ASSESSED VALUATION
S• State Form 43709 (R71 / 6-09)
���-��' Presrnbed by Deparonent ot Lacal Govemment Finance
INSTRUCTIONS:
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To be (led in person or by mail. Qq^��'^'�NO, �
Filing Dafes: iJ Real Pioperty: Must be completad and dafed in the calendar yearlo� which fhe deduction is Sought. V �
Must be filed with (he Counry Audiror or Counry Recorder o! 1he rnunry where fhe property is /oca�ed Coun y Auditor
on or before January 5 o7the immediafety succeeding calendar yeac C� unry Recorder
2) Mobile / ManWacfured Homes not assessed as Real PropeRy: Must fi/e with fhe Counry Audiior o� the
counry where the property is locafed dunng fhe Rvelve (12) months be/ore March 37 of each year the
deducibn is sought. OIBSON COUNTY AUDITOR
See reverse side for addifional ins[ructions and qualifications.
Ap�wm (owner w con✓act buyer - see re.wictions on reverse side)
Jimmy D and Kimbedy A Slater
Tating Disincl Key number I legal tlescnplion Record number Pa e number
Princeton 26-12-18-202-002.594-028/ Pt Lt 336 South Side Addition ab �� � y U
AssesceE ralue W real properry as of Mwtgage / Con;ract intleGtedness unpaid as of Mwtgage / ContraC inEebtednaw unpaid as of Is �he applicant Na sole
March 1, wrtent year March 1, wnent year date ol appGcation legal w equitada owner7
72364.00 0 Yes ❑ No
If no, w�at is his / her exaG stwre at interest7 If ownetl vnih someone o:her Nan spouse, indicate vrtlh whom
If name on remrd is diRerent than Nat of applicant, inCiwta bebw: Is Na pmperty in QuesUOn: Annually A5se55eG
_ ❑� Real FroPeM ❑ MnuaOy Assessed
Mobile Home (IC 61.1-7)
Name of mortgagee or wnvac� se0er
German American Bank
Atltlress of rtwrtgagee or contract se0er (numGer aM street. city, s1a�e. and ZfP cotle)
711 Main Street Jasper IN 47547
Name of assgnre or ather owner or hoNer o1 mortga9e
AEdress W assynee (number antl sUaet dry. uate. and ZIP tode)
Does applicant own pmpeRy in any oNer If yes, what counry9 What Taung Districl? Has Nis Ceductirn been mpuestetl on pmperty
counryinlrMiana4 ❑ ❑ forwrtentyear? � Yes ❑ NO
Ves J No
COUNTY AUDITOR
Deduttion aOP�oved in Ne artwunt of:
2o zo _ zo _ zo zo _ zo 20 _
Signature of Counry AuEitor Counry Date (r+anM, day, yea�
I I We ceAiy under Ihe penalry of perjury that Ihe above and foregoing infortnauon is We and cortect and [hat lhe applicant is a resident ot Indiana and
owner I contract buyer of the aforementloned property on date applicauon is filed.
g mre (owners IWI nam¢) Date (mmth, day, yea�
11113112
F II siEent address a pdicant (numDer aM strea4 ��N yaie, antl ZIP cotle)
612 E Kentu Pnnceton IN 47670
Person auNOraeE by Auy executed Power o� Attomey or Gy IC 61.142-0J Date (monN, tlay, yea�
Atltlressotauthwizedperson (numGeraritlsveef.city.slafe,antlZlPcoda)