HomeMy WebLinkAboutMortgage_Goddard <0 rzt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
qtr 4't FOR DEDUCTION FROM ASSESSED VALUATION
Jt 2016
0. , State Form 43709(R12/6-14)
\ r/ Prescribed by Department of Local Government Finance ��`l�k�Fir
I411•
INSTRUCTIONS:
To be filled in person or by mail. Form filed with:
Filing Dates.- 1)Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the county where the PR $ Z(I'fi
property is located on or before January 5 of the immediately succeeding calendar year. &aunty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property: Must file with the County Auditor of the
GIBSON COUN❑'car--
County Recorder
county where the property is located during the twelve(12)months before March 31 of each year the for additional –
den isaught. AUDITOR
See reverse side for additionnal instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
John R. Goddard and Amy L. Goddard
Taxxiirr�lgg//ppistri5y Key number/legal description 26-23-16-200-002.480-024/1660 E Autumn Record number Page number
/X.,�/_01,0711-79 Ridge, Haubstadt, Indiana 47639 CIt7�&, 014�"
A ssed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
ch 1,current year March 1,current year date of application legal or equitable owner?
S291,650.00 ❑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 ❑AnnuallyAssessed
Mobile Home(IC'6-1.1-7)
Name of mortgagee or contract seller
Heritage Federal Credit Union ---. - -- - — — — —
Address of mortgagee or contract seller(number and street,city,state,a - I ` I (e(,
5388 Old State Highway 66, Newburgh, IN 47629 _ l 1
Name of assignee or other owner or holder of mortgage , °l•..v`uR. v4 h xxl L. Co brkokrke lx
Address of assignee(number and street,city, stare,and ZIP code) *"Uc ` ` Fc.t' kt-S-I L
Does applicant own property in any If yes,what county? W $ "'- ` t (O S C 6 1 If yes,state amount of
other county deduction
in Indiana? ❑ Yes ❑ No 'current year? U Yes u No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
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 I We certify under 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 pro erty on date application is filed.
Si ure(owners full n e) 1 Date(m t day year)
a Z (�dc�a ��31),Y
Full resident a ress of applicant(nu lief and street,city, state, a ZIP de)
1660 E Autumn Ridge, Haubstadt, IN 47639
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)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.