HomeMy WebLinkAboutMortgage_Goldman (3) aba STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' =: FOR DEDUCTION FROM ASSESSED VALUATION ;
Static Form 43709(R73/ibt�
�- Presrnbed by Department of Local Government Finance 1
INSTRUCTIONS: ile(Mark
To be filed in person or by mail. JUL J U L 6 20 corn filed with:
Filing Oates 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought
Must be filed or postmarked wilt?the County Auditor or County Recorder of the county where the pro rty.is unty Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County AGdR&Jtdeyee ❑ County Recorder
where the property is located during the twelve(12)months before March 3l of each Y Av l IIITQR
See reverse side for additional instructions and quafrfications. year the deduction is t
Applicant(owner or a 4-contract buyer-see nr�/Ptt-side)
T Key number!legal description Record number Page number et-trEe,J Ato - ii-/b - aoo -000 . /7 9-Oaf 2OI c . 04403
Assessed value of real pmpe as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year a44.444ment date,current year date of application legal or equitable owner?
71 000 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than srx is,,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 6-1.1-7)
Name of mortgagee or contract seller
‘leeArso.)
Address of mortgagee or contract seller(number and city,state,and LP code)
Name of assignee or other owner or holder of mortgage
Ad9 of assignee(number and street,city,state,and ZIP code)
Pr 4.0 NE 1c, - l.- (1 . 82.6 A c Drawer NO. 070
Does applicant own property in any It yes,what county? What Taxing District? ddeedu for
in Indiana? ❑Yes El No current year Card NO,
A person is not entitled to this deduction unless the person has a balance on the person's mortgage ors ''"'""••••••••-
recorder's office(including any home equity line of credit that is recorded in the county recorder's office,_._..__._ _.
COUNTY AUDITOR
Deduction approved in the amount of
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20 20 20 20 20 20 20
Signature of County Auditor County - Date(month,day,year)
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I/We certify under the penalty of perjury that the above and foregoing infomtatton is true and correct and that the applicant is a resident of Indiana and
owner f contract buyer of the aforementioned property on date application is filed.
.� Signature(owner's full name Date(month,day,year)
atl app5cant(number and street city,state,and ZIP code)
Z $771, w -7Ss —tine?-tot4 t 47 (a70
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
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Address of authorized person (number and street city,state,and ZIP code)
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The penalties for perjury can include imprisonment up to two and a hat years and a fine not to exceed$10,000. .