HomeMy WebLinkAboutMortgage_Goedde (3) 4 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION T
L-_ s�-�=J State Form 0.3709(R11/6o9) F 1 LI
��R�A ResaibeO M DefimeN of Laol Goremment Fuanca
pile Mark
INSTRUCTIONS: ,p�
To be filed in person or by mail with the County Auditor or County Recorder of the county where the pmp¢4&atel 014 Form filed wNu
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 21t1 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before Marsh 31 of each year the deduction is sought - ///77�( ❑ County Recorder
See reverse side for additional instructions and quali fications. GIBS()N r`r111 �
Appliant(gwnjr or �r-see restricnons� on revs,siside) � � TK AUDITOR
� I( � r7 1n ���fff
Tad D' Key number/legal desaiptim manner P
(C-/ -i 3 tioa ,2O si5 -r), h /�
Assessed value of rear property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Comaact indebtedness unpaid as of Is the ap the sole
Math 1,current year March 1,current year data of appSmtion legal or equitable owner?
g 9 ❑ 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
❑Real Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contact seller ----/r .
Address of mortgagee or contract seller(�and street ,and ZIP Name of assignee or other owner or holder of mortgage -
Address of assignee(number and street,city,state,and LP axle) - - - Q .'.I..1......
Dra\V'er NO
...Tl+1
Does applicant own property in any other If yes,what(aunty? t f en requested on property
county in Indiana? 11
❑ Yes ❑ No .........� ❑ Yes ❑ No
` Card NO. .........
Deduction approved in the amount of f�Y��� 431.9g5 .
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!contract buyer of the aforementioned property on date application is filed.
Sicrhaei Date(nnilh,day.year)
'�(FUI' ' e o address o rant(nu rend street oTy,state,and ZIP code) _ /�/�
(son authoived by duty executed Power of Attorney or by IC 61.1-12-0.7 Data(month,day.year)
Address of authorized person (number and sneer,city,state,and ZIP code) .