HomeMy WebLinkAboutMortgage_Goldbach (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County o Year
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FOR DEDUCTION FROM ASSESSED VALUATION I /
J State Farm 497e9 Department/609)
ee@�+--..::�'' Presrnlbed by Departmem of Lod Government Finance
File
INSTRUCTIONS: ����UU
Form filed with - t
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located. 114
Filing Dates: 1) Real Property Must file during the year for which the deduction is sough[ j Coun Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months GL r., ,,. i
before March 31 of each year the ded• l'HI is sought •O'er 0•:•Di/1NiI:'..-
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See reverse side for additio al instructions and q =lift :dons. .()D ,O
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A' ,. ions/ uyer-s sie) / -
T..: • Key number/legal description Record num�f>r/r Page number
' 9.38- �j .do/5` /�
Assessed value cereal properly of =arm,/Cont ye indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of is the r equiant the sole
March 1:current year MMaamrchh 1.curter[year date of app / eO D �� ❑ 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 rend is different than that of appficant•indicate betovc Is the property in question:AnnuatyAssessed
❑Real Property ❑Anrntaly Assessed
- Mobile Hoe(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet ay,=M.and ZIP code)
Name of assignee or other owner or holder of mortgage -
Address of assignee(number art,'-'
l
Does aF �I • What Taxing District? Has this deduction been requested on property
county u. ' )( for rurtem year?yea
IWn" CI-)L? ❑ Yes ❑ No
�nI /n; � VTY AUDITOR
Deduction: '/` n'not a'-
20 I /3O 11 20 20 20 20
Signature of C County Date(month.day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and cored and that the applicant is a resident of Indiana and
owner I• ntract buyer of - aforementioned property on date application is filed.
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Signatu (e: hl �:/•..• Date(month,day,year)
F rrrS•ent f•• o -pageant(number. •sheet oTy,state,and ZIP code)
r-• 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.meet city,stare,and ZIP code)