HomeMy WebLinkAboutMortgage_Goodloe (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ..Aryl I T.1 h .a, Year
p �y�
FOR DEDUCTION FROM ASSESSED VALUATION
t'. State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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srRUCnor/s: • ed kith
be filed in person or mail with the County Auditor or County Recorder of the county where the properly Perm Aed -
Pe by b tY N P PerfY is boated.
Filing Dates: I) Real Property Must file during the year for which the deduction is sought. I �] ,
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months fr-'1►ji g
before March 31 of each year the deduction is sought G IBSO N C OUN ml A l o l l q�L prdef
See reverse side for additional instructions and qualifications.
Appfirant(owner o con trt buyer-see restrictions on reverse side) �(•
Taxing District h'r�Yl` /�description ✓,~/�11 rob r Page number
a‘= a•is- 304-coo. 9 -02'Z 3' kJ
Assessed value of teat properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact Indebtedness unpa4Sfof Is the applicant the sole
March 1,current year March I.p rot year_ date of application 4 legal ore equitable O
I l al t/�J U(/ yes 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
El Real Property ❑Annually Assessed
Mobile Home(IC 8-1.1-7)
Name of mortgagee or contract seller 9 •Ale/0 _ . .
Address of mortgagee or contract seller(number end street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage ___.�w—t���M K1 _
Address of assignee(number and street,city,state,and ZIP code) ����— ' "r��/" Q � S
Does applicant own property in any other If yes,what county? /3 3 7? `/ 1 been requested on property
county in Indiana?
❑ Yes ❑ No _ ❑ Yes ❑ No
Deduction approved In the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County ' Date(month,day,year)
I 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/contract buyer of the aforementioned property on date application is filed.
lure(owneh NO name) l•,.• Date(month,day,year)
A reside add applicant(number and street olly,state,and ZIP code)
Person Pers authorized lby duly executed Power of Attorney or by IC 6-1.1-12-0.7 i Date(month,day,year)
Address of authorized person (number and sneer,city,state,and ZIP code) .