HomeMy WebLinkAboutMortgage_Goodson (2) STATEMENT OF MORTGAGE OR CONTRACDiB�EDI6S County Township Year
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`,;:. FOR DEDUCTION FROM ASSESSED VALU O �
-- -(' State Form 43709(R11/609)
Prescribed by Department of Local Government Finance MAR 13
m 2013
File Mark
INSTRUCTIONS:
To be filed in person or mad with the County Auditor or County Recorder of the h Form filed
pe by ry ry /s rotated.
Filing Dates: 1) Real Property Must file during the year for which the dedg1{GGt�pppp s County Auditor
2) Mobile/Manufactured Homes not assessed as Real Propb tjP UNi tj-Qtf 01C08 Ronths
before March 31 of each year the deduction is sought. County Recorder
See reverse side for additional instructions and qualifications.
Appti nt(owner or contract buyer-see resfidions verse side)
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Tad Di T Key number I legal description Record number Page number
ion ) aco-1 -o --4/0 / C0 3 if09 oQe go 1 3 8 a2
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app&cant the sole
Mardi 1,area year Mardi 1,current year - data of application legal or equitable owner?
3 cc
c - _ _ ❑ Yes ❑ No
If no what is his/her exact share of interest? a SW/ 6,f oE�63 `Wkate with whom
If name on record is different than that of applicant,indicate below: V CO l/`J V (�J 5(/ 43// C merry in question:Annual/Assessed
V I Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
o N13 01°45-PaA
Address of mortgagee or contract seller(number and street,city.at •
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ Yes ❑ No
fraWnialtalra
COUNTY AUDITOR
Deduction approved in the amount of _
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(o r hit name) Date(month,day,year)
FW residence/}`mot Ross aPWrant(number and sheet,city,state,and ZIP code)
s/l- co77 AJtrooD ,DK , /R/A✓ec7a u/ i.✓ 9767o
authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code)
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