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HomeMy WebLinkAboutMortgage_Martin (8) e Z j="� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year (- ; FOR DEDUCTION FROM ASSESSED VALUATION I 6 ,. State Form 43709(R10/11-08) FILE„ice Prescribed by Department of Local Government Finance �1 �' _1 ). INSTRUCTIONS: gig File Mark To be filed in person or by mail with the County Auditor of the county where the property is located. JUL II II q 2013 Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. J O 2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months before March 31 of each year the deduction is sought. /1, See reverse side for additional instructions and qualifications. ,71.1Y1LI Applicant(owner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDI I OR Larry Martin Taxing District Key number/legal description Record nun r Page number Princeton Township 26-12-07-102-003.727-028/Pt Lot 2 Forest Park Add. Q013 .tea y,8 Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,current year date of application legal or equitable owner? _ ____ 5125,000.00 © Yes CI No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed ©Real Property ❑Annually Assessed Mobile Home(IC 61.1-7) Name of mortgagee or contract seller German American Bancorp Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code) 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? for current year? ❑ ❑ ❑ Yes Yes No ❑ No 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 pe•!y of perjury tha Ale above and tore•oing information is true and correct and that the applicant is a resident of Indiana and A owner/contract buyer°A •rem'• ion- roperty on d:.0 ication is filed Signature(owner's f______a.A_ALL- D1D2 Full resident addre-- • n • Ir and street,city,state,and ZI:code) 303 W.Spru -,-rince on, IN 47670 Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street,city,state,and ZIP code)