HomeMy WebLinkAboutMortgage_Martin (11)a,.±:.'�4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count
Si'�.�! FOR DEDUCTION FROM ASSESSED VALUATION '-
Sate Fwm 43709 (RN / 6-09) �
���' Presvi�ed by Department ot Local Govemment Finance
INSTRUCTIONS:
io be fifed in person or by mail.
Filing Dates: 7) Real Property: Must be completed and dated in the calendar year Ior which !he deducfion is soughf. Df
Mus( be filed with the County Auditor or County Recorder of the county where the propeRy is locaied
on or belore January 5 o/the immediatety succeeding calendar year.
2) Mobile /Manufactured Homes nof assessed as Real Property: Must file wifh tAe CounryAuditor o/ffie
county where (he property is locafed dunng �he twelve (12) monfhs before March 37 0/ each year the C�
deduction is sought.
See 2verse side fa additional instructions and quali�cations.
Aodifant Iowner w contrdct bvver - see ieunctions on revarse side)
Timolhy John Martin
Tazing Disuici
Princeron
AssesseE value of real pmpeny as o/
Mamh 1, uirtent year
no, w�2t i5 �is / h¢r ¢xact
name on
File
1 �:2 W �nty Auditor
��' Counry Rewrder
KeynumbeNlegaldesuipGonRT"'_e-�-+- . Rewrdnumber pa�.1nb41'Vnen4
-""'°''` . �- 20120!UJ06437
26-12-07-102-000.934-028/�Pt.lt-107�Ong�Ptan Princeton
Mortgage / ConVact inaebtedness unpaiE as of Mongage / Contract indebteEness unpaiC as of Is the applirant Ne sole
March 1, wnent year date ot apPGwtion legal w equitaWe owner7
61355.00 ❑ Yes ❑ No
;erest? If owne0 wiN someone oNer ihan spouu, indicate wich whom
Name ot mMgagee or Contratl SeDer
German American Bank
Address of morcgage0 or ConUact seller (number antl street, city, siate. and ZIP cotle)
711 Main Streei Jasper IN 47547
Name of assianee or oNer ovmer or IwlCer ol mortoaoe
uare,
Oaes applicant rnvn property i^ any alher I If yes, what county? I VJhat Tadng DiSWct?
wunry in Indianai
❑ Yes ❑O No
ISIhe property in Queslion: Mnua�yASSessed
] Real Property ❑ MnualyASSessed
Mobile Home (IC 6-1.1
s mis aeaucnon oeen requesrea on Omperty
wrteni year7
❑ Yes n No
COUNTY AUDITOR
Deduccion apprwed in Ne artqunt of:
20 20 20 20 20 20 20
SgnaNre ot Counry Auditor Counry Date (mwnN, day, year)
I/ We certify under :he penalry of perjury Ihat Ihe above and foregoing intortnation is We and cortect and that the applicant is a resident of Indiana and
owner I wnVact buyer of the aforementioned property on date application is filed.
Signat re rs luq na ) Date (mmth, day, yea�
1217112
W resiAent a�ess applicant (number aM s✓eet, ciry, sta;e, antl ZIP cotle)
214 W W nut St Princetan IN 47670
Person au1Mr¢eE by Cuty executetl Power o/Attomey or by IG 61.742-0.7 Date (month, tlay. yea�
Address of authonze0 person (numberaM sbee( ciry, sfafe, and ZIP code)