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HomeMy WebLinkAboutMortgage_Smith (34) 4 7tY'o 'STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I Township I Year /.a$ FOR DEDUCTION FROM ASSESSED VALUATION ix i • State Form 43709(R10111-08) ® \ - Prescribed by Deparbnent of Local Government Finance ' INSTRUCTIONS: F.�• Ma Y To be filed in person or by mail with the County Auditor of the county where the property is located. - r... Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months be(orlt c®31 o7pagh year the deduction is sought. iJ! C U 13 See reverse side for additional instructions and qualifications. _ Applicant(owner or contract buyer-see restrictions on reverse side) Jill Marie Smith and Brian Lee Smith GIBSON COUNTY AUDITOR Taxing District Key number/legal description I Record number Page number Princeton 26-12-06-401-002.383-028/A pt of the NW Qtr of the SE Qtr of Sec.6, /3- c,//SS 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.anent year March 1,current year date of application legal or equitable owner? S172,800.00 © Yes ❑ No II no.what is his/her exact share of interest? If owned with someone other than spouse.indicate with whom II name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed El Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller German American Bancorp. Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 711 Main St.PO Box 360 Jasper,IN 47547-0360 1 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? I What Taxing District? Has this deduction been requested on property county in Indiana? for current year? ® ❑ Yes ❑ No ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount of: 20 20 1 20 20 20 20 20 Signature of County Auditor County I 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 bu er of the aforementioned property on date application is filed. Signature(owner e)r c7 ..Q[N/4// Date(month,day,year) A' 7-if. Zara Full resident address of applicant(number and street,city,state,and ZIP code) 207 Hawthorne Dr. RiehlenJ, lFJ 4YB9fl Qr Mti.1/2.,..n —St..._1 4{ tta?t Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number end street,city state.and ZIP code)