HomeMy WebLinkAboutMortgage_Goldman EDSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION I �(State Form 43709(RU 1 6-09)
Prescobed by Department of Lo al Government Finance
File Mark
INSTRUCTIONS: a • ' .
To be filed in person or 6 mad with the Coup Auditor or Court Recorder of the county where the property
Pe Y h N h' P PertY is located.
Ring Dates: 1) Real Property:Must file during the year for which the deduction is sought minty d'rtor
2) Mobile/Manufactured Homes not accessed as Real Property:Must Re during the twelve(12)months
before March 31 of each year the deduction is sought emrder
GIBS _ e _ S _
•
See reverse side for additional instructions and qualifications.
Apr/Kant( b(Jll/r see onre
T 'strict Key number/legal description Record number Page number
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of I Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Maur 1:extent year March 1,anent year date of a pfxation legal or equitable owner?
too 000 ❑ Yes 0 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 hdicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city.state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of a(number and city,state,and ZIP code)
Kt street rNE la - a-Ii • 2SA- C Co LOYNAii, VO&t sr
Does applicant own property in any other If yes,what county? • What Tare CfIZD I✓ J
county in Indiana?
❑ Yes ❑ No o
COUNTY AUDROF 14 - 50269
Deduction approved in the amount ot. -
20 20 20 20
/ ,�—� I I
Signature vrAy Auditor ., i�\�� „,.... County Date(month,day.year)
l
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.
Signature(owne full name) Date(month,day,year)
Art/44 ate,.
YF resident t(flimflam'and street O M state,and ZIP code) /
1
Person a I(1, tratu ,94 Pm ti oft ��n t l 7(Q v> p .
Person authored by drily executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .