HomeMy WebLinkAboutMortgage_Goodman (5) zSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form a3709(R 13/10-15)
,�„ Prescribed by Department of Local Government Finance
INSTRUCTIONS: File Mark
To be filed in person or by mail. Form f'ed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought
Must be lied or postmarked with the County Auditor or County Recorder of the county where the property is III County Auditor
located on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Christopher&Tricia Goodman
Taxing District Key number/legal description R�c(fyrpbe/ Page number
Montgomery 26-18-06-300-005.455-021 �1V1`` 1K-1 5-
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant sole
assessment date,current year assessment date,current year date of application legal or equitable owner?
140000 ❑p 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
0 Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller r-�
Vanderbuilt Mortgage & Finance f(, 00 D MA/_
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Address of mortgagee or contract seller(number and street city,state.and ZIP code)
CIA rus1DP► 1
Name of assignee or otter owner or holder of mortgage - RLeil
Address of assignee(number and street.city state,and ZIP code) I("c I AS
Does applicant own property in any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other Indiana? ❑Yes ❑! No curr on ent year` ❑O Yes ❑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)
...-.d I„ Gibson 05/14/19
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 I contract buyer of the aforementioned property on date application is filed.
Signature(owner's full name) Date(month,day,year)
4 _ 05/14/19
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Full resident address of applicant(number and street,city,state,and ZIP code)
6516 W Old Princeton Road, Owensville, IN 47665
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 pequry can include imprisonment up to hvo and a half years and a fine not to exceed$10,000. k ii
RECEIPT FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS AQp
Name of applicant Name of mortgagee or contract seller '�/ ,l
Christopher&Tricia Goodman Vanderbuilt Mortgage & Firfft I ea
Date tied(month,day,year) Amount of indebtedness Taxing District xtr .9
05/14/19 $140,000 Montgomery °OG
Key number/legal description �Tk.
26-18-06-300-005-455-021 11./
Signature of County Auditor/County Recorder County Date(month,day,year),OR
�- 9r,..tkj4 Gibson 5/13/19