HomeMy WebLinkAboutMortgage_Goldbach (2) 4,0T-'*fo STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r i FOR DEDUCTION FROM ASSESSED VALUATION
j� RECEIVED Gibson 020 2020 r. ! State Form 43709(R14/1-20)
re a Prescribed by Department of Local Government Finance
SEP O12019 File Mark •
INSTRUCTIONS: To be filed in person or by mail. Q�(_T A Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. u County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property
is located on or before January 5 of the calendar year in which the property taxes are first due and payable. ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
Kenneth C.Goldbach and Robin A. Goldbach
Taxing District Key number/legal description Record number Page number
Patoka 26-04-25-300-000.653-020/Hudson Farm West Ph 2 Lot 5 `liO 363
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 date of application legal or ee ciitable owner?
r-
$0.00 $278,000.00 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 th�roperty in question:Annually Assessed _-
LK Real Property 0 Annually Assessed
F L EO Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Indiana Members Credit Union
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
4790 E. 96th Street,Ste. 120, Indianapolis, IN 46240 SEP 0 8:2020
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) Y�i,•tii
GIBSON COUNTY ,: ;TOR
Does applicant own property i any If yes,what county? What Taxing District? Has this deduction been requested If yes,state amount of deduction
other county on property for ❑ Yes ElNO
•
in Indiana? El Yes NO current year?
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 1 / County Datelmonth,day,year)
Avon Gibson C1 • g-2o 210 _
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 property on date application is filed.
,rdignatur wn s full name) / yiDate(month,day,year)
Full resident address of app cant(number and street,city,state,and ZIP code)
601 Cardinal Dr., Patoka, IN 47666
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)
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