HomeMy WebLinkAboutMortgage_Goldbach (2) l *P� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
° `rs\ FOR DEDUCTION FROM ASSESSED VALUATION
�`'-, -./ ' State Form 43709(R13/10-15) RECEIVE® �� • O�"
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0 � Prescribed by Department of Local Government Finance lv1
INSTRUCTIONS: -, ,, _ f�.""''JT JAN 131011 File Mark
To be filed in person or by mail. c, Form filed with:
Filing Dates: 1) Real Property:Must be c pleted 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.
•
Aoolicant(owner or contract buyer-see restrictions on reverse side)
Goldbach,Chase and Kimberlee
Taxina District Key number/legal description Record number Page number
028 26-12-06-204-001.518-028/NORTHBROOK HILLS 55 r-220 tl,.I, f
Assessed value of real property as of Mortgage 1 Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant a sole
assessment date.current year ,assessment date,current year date of application legal or eauitable owner?
195500.00 186675.00 174.000.00 x Yes CI No
o ed If no,what is his!her exact share of interest? her than spouse,indicate with whom
ilik�r
r
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
ial U BP x Real Property ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortaaaee or contract seller
Legence Bank )
Address of mortgagee or contract seller(number and street,city,state.and ZIP c•.11 , i yNT1; Yli3fTOR
PO Rnx 569.Eldorado.IL 62930 GIB-ON COUNTY rt. "TOR
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,slate,and ZIP code)
9•es applicant ownproperty in r `' If yes,what county? What Taxing District? Has this deducti n een requested If yes,state amount of deduction
•her count . ' on property for
o ndiana? _D ice- ►4 No current year? Yes ❑No
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or o tract 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)th t is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 2 20 (...,.) 20 20 20 20
r
Signature of County Audi 40,,
� County I `,^ Da (mo the fqy ag
�� 1 • 13 OI\ L 1
1/We certify under the penalty of perjury that the abo a egoing information i t e and correct and that the applicant is a resident of Indiana and
__ -__owner/contract buyer_of the-aforementioned propert_on. ate application is filed. ---- ---
S//ign ur (owner's full name k Date(month,daffy,year))
Full resident address of aoolicant(number and street.city.state.and ZIP c 1
1808 Cottonwood Drive.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) •
T,--•-,,,-.if:..,,fr.-nor,,n,non:nrh,,fo imnnennmanf,,n fn firm and a half vaarc anria fins not in ovcaari.R?n non