HomeMy WebLinkAboutMortgage_Freudenberg'°* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ � FOR DEDUCTION FROM ASSESSED VALUATION
State fwm 43709 (R11 / 6-09)
� w. � PresaiCeO M DePaRment of Laml GwemmeN Finarce
�STRUCTIONS:
To 6e filed in person w by mail with Me CounryAutlitor or Counry Recorder ol Ne county whe2 the pioperty is located.
Filirg Dates: 1) Real Property: Must file during the year for which the deduction is sought.
2) Mo6Ae /ManuFactured Homes not assessed as Real Property Mustlie dunng the fweNe (f2) rtwnths
6efore March 31 0/ each year the deduction is sougAt.
See reverse side lor addihonal instruclions arM qualficafions.
AppGranilownerwconOaCbyrer.-seeresfrirtiorxmreversesitle) //� / _
.� . n A
�
c�,��, a� - ��- a. - 300 - oo�.
AneaeO vdlue of real paperty as of Abrtqaue / Conbaa'uMebtednes unpaid as of I
Mart3� 1. �t yrar Mamh 7. airteM year
tl m, what's his / Mr e�ct share ot interest? Ii ovmed
If name m remd is dfierart than that ot aPW�^�• u�Aicate bebw:
Name ot morcgagee or contract seller,/((/J
T 11C%-f�I'
Mtlress of mortgagee ar wntract seller (nwriber and 5G
Name o( assignee or other ovmer w hdder of mortgage
naaress o� amgnee (numner aiw sm
w
�a��� E ,�„�;S�cJ
counry in Ind'ena?
❑ Yes
I
DeAUCtion approved in Ne amount of:
�
20
I I We certify under Ne penalty of
rnmer / conVacl buyer of Ne afon
ciy, state. ardZlPCOde)
cay. s+aie, a� ur caae�
�.A_,z_
3R c.
What Tapn
COUNTY AUDROR
20 _ � 20
Counry
20
� C`,ounty9A�U�d�itOr�
}�N cio�tyR�Eaaer
i��t
as d Is Ne appfiant Ne sole
legal a eV�tah�e axneR
❑ Yes ❑ No
spouse, indicate v.ith whwn
p property in pues0on: Mnua�y A1ses5eA
Rea� ProaeKV ❑ /+��r Pssessed
r REUOt� Q��,
m reN r�c. �
sA RA 0
Id—l��
20 20
' ..?�7
Date (rtmfh. day, laa�
�he a6p�e anE foregoing infortnalion is We and torteCt a� Ihat the appliCant i5 a resident of IMiana arM
pro%y� �j on date applinbon is filed.
Date (month, day.War)
Full re4Cent aCA of applirant (numDer antl sheeG city, sfafe, antl ZIP mde)
309.3 s. �oO E. a�/��g,�� c;ry .z,.�•
Person auNOfrzetl by duy executed Porer o( Attorriey or by IC 61.1-12-0.7
AtlCress of autha¢eC person (numberantl sbee4 cily. sbte, aM ZIP cnde)
day. 3��