HomeMy WebLinkAboutMortgage_Baleda �SNE,f 5�? STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
°y ':R, FOR DEDUCTION FROM ASSESSED VALUATION
\ ' L) State Form 43709(R13/10-15)
� Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed 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 property is ❑ 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)
Carl W Baleda
Taxing District Key number/legal description Record number Pa umber
Princeton 26-12-07-402-003.193-028 'Zo 2O m _
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year dat f application legal or equitable owner?
'/� .....
, 6 EYes ❑ No
If no,what is his I 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
Cgt Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ILE `
German American Bank
Address of mortgagee or contract seller(number and street,city,slate,and ZIP code)
711 Main St., Jasper, IN 47546 BAN 15 �020
Name of assignee or other owner or holder of mortgage a
Address of assig 0N
�`p� � Tv RUnr7
Does applicant o ti strict? Has this deduction been requested If yes,state amount of deduction
other county T y . on property for
in Indiana? [ D rati`'er N O current year? ❑Yes ❑No
A person is not r i n the person's mortgage or contract indebtedness that is recorded in the county
recorder's office \' the county recorder's office)that is the basis for the deduction.
Card NO. JTY AUDITOR
Deduction approv, 1
• •
20 20 20 20 20 20 20
Signature o o yAuditor County Date(month,day,year)
171J
I 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(owner's full name) 'Date(month,day,year)
--w( GJ e,.P .S:--e. - Jai r v, 31, ,2c) ..0
Full resident address of applicant(numbevn nd street,city,state,and ZIP code)
603 E. Broadway St., Princeton, IN 47670
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 no,, ltioc fnr norienni can inrinrie imnri-ennment on in two and a half years and a fine not to exceed S10.000.