HomeMy WebLinkAboutMortgage_Williamson�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township .Year
-� __ 4 FOR DEDUCTION FROM ASSESSED VALUATION T
y�%� S�ate Fwm 43709 (R71 / 6-09) . � jr��.- �,'
♦� � � " ' +
-�� PrescnDed by Deparonent o! local Govemment Finance '�'
,•�• File Mark� "'` -4i.
INSTRUCTIONS:
To be lled in person or 6y mail. f � �Z
Filing Dates: i) Real Property: Musf 6e comple(ed and dafed in the calendar year tor which fhe deducfion is sought Coun Auditor
Musf be filed with (he Counry Audiroi or County Recorder of the counry where fhe pmperty is located � H
on or be/ore January 5 07 the immediatety succeeding calenda� year. Rewrder
2) Mo6ile / Manu/actured Homes not assessed as Real Property: Must fi!e with (he County Aud'rtor o/ the
county where fhe property is locafed dunng the fwelve (72) monfhs before March 37 0! each year fF�16SON COU
deduction is sought �'�TY AUDITOR
See reverse side Jor additional instrucfions and qualifications.
Applican� (owner a conVact bvyer - see reslnctions on reverse siJe)
Jordan P. Williamson
Taprg District Key number I legal desmplion Recotd number Pa�e number
Princeton Township 2G12-07303-003.312-028 / Pt Lot 4 in Laure E. Woods Addition (
Assessed vahm d mal property as of Mwtyage/ ConmdC i(WeWedneu unpaid as ot Mo�gage / Con;raU indebtadness unpaid az of Is �he applicant Ne sole
March 1, wrzent year March t, artent yaar date of appfimtion legal w equifable owner7
S83,361.00 0 Yes ❑ No
If no, what is his I her exaa share of interesl? If wmetl wiN someone olher than spouse, indiwte wiN whom
It name on recoN is tlifterent than Nat of appGwnt, inEiwte bebw: Is Na pmperty in quesUOn: MnuaOy Auessed
Q Real Property ❑ MnuallyAssessed
Mobile Home (IC 61.1-7)
Name ol mortgagae a wnVad se0er
German American Bancorp
AdGress of mortgagee or conVaci seAer (num0er and shaeC ary, sfale, and ZIP caCe)
711 Main St., Jasper. IN 47547 �
Name ol assignee or other owner or 1wMer of mort9age �
AdEress ol assignea (number aM SLeeG ciry. stare, antl ZIP cotle)
Dces apqifant own properry in any oNer If yes, whal munryl W�at Tazing DistnU7 Has ihis deduction been repuasted on property
coun m InEiana? for wrtent eaR
h ❑ Yes ❑� No Y ❑ Yes ❑ No
COUNTY AUDITOR
Deduction appwed in Ne amount of:
zo_ 20_ zo zo_ 20_ zo_ zo
Sgnature of Counry Auaimr Caunry Date (month, day. yea�
I/ We certify under �he penatty of pe�ury that Ne above and foregoing infortnation is true and wrtea arW that [he applicani is a resident of Indiana and
owner I contract buyer of the aforementioned property on date applicauon is filed.
Sign a(ownerslull n . �ale (monN, day, yea�
C
Full re nt aCdreu of ap ¢a t(nu aiM st+eet uty, sfate, antl ZIP code)
713 Hall St., Princeton, IN 47670
Person autMnzeG Dy Euly ezecvted Power of Attomey or Oy IC 61.1-12-0.7 Date (mwdh, day, yca�
Addressofauthorrzedperson (numberandstreaf,ciry,sfate.andZ/PCOde)