HomeMy WebLinkAboutMortgage_Goedde (2) .o• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township j Year
FOR DEDUCTION FROM ASSESSED VALUATION lr+ t t
State Form 43709(R11/6-09) Gibs Prin 2015
Prescribed by Department of Local Govemment Finance A
File Mark
INSTRUCTIONS:
To be filed in person or by mail. ■ems'led )
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ Cou ty Auditor
on or before January 5 of the immediately succeeding calendar year. ty Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor ON -
county where the property is located during the twelve(12)months before March 31 of each year ML•" - - - • • -• -
deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Daniel A.Goedde
Taxing Branch Key 6-19-1r- 03-000.371 ' L PapE1 �
Fort Branch 26-19-18-303-000.371-026 _uL 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the ap cant the sole
Mardi 1,current year March 1,current year (tato of aoo&ation legal or equitable owner?
72,900 R V ,C\C6 S Yes ❑ No
If no,what is his I 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
0 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 Street,PO Box 360 Jasper, IN 47547
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 ❑ No ❑ Yes ❑ 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 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.
grature ..'"""s tuff name Date(month,day,year)
07/03/2013
resident address of ap cant(number and street,city,state,and ZIP code)
406 E Strain St.Ft.Branch,IN 47648
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 and street,city,state,and ZIP code)