HomeMy WebLinkAboutMortgage_Maurer^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o ip
,_ .= FOR DEDUCTION FROM ASSESSED VALUATION
• , • Stale Form 43709 (R71 / 649)
� P�esaibetl by Departmerd of Laal Govemrtrent Frence
� fl��12 2011
Fil
� INSTRUCTIONS:
Form IH with:
To be filed in person w by mail with the Co�nryAUditor o� Counry RecoNer o/ the county where the pmperty is located. C�,
Frlirg Dates: 1 J Real Property Must file durirg the year /w which Ihe deduction is mught. � Coun di
2) Mo6ile /Manufactured Homes rrot assessed as Real Property: Must file dunng the fwelve (72J months n �R
6efore Ma�ch 37 0/ eaGr year the deduclion is sought BSl4?! CI�I�Y 170R
See reversa side /or addifional insVUCGOns aM qualificafions.
App�rant (o � ar coyyact buyer- see msbi�0'ons on revy,ke side)
_, �_
Y real pap.+ly aS
1�
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Wn that of appGrant, rt�tlinte Eebw.
Name of rt�ort9agee or mntraU seAer
Address of rtprtgagee of mntraq
ownet
i Record number Page numbu
-/o�-Ooo• Oa-/-O� J 0 6�
G intlebtedrress unpaid as of Mortgage / Contract udebted�ess unpaid as of Is Ihe eppGOnt Ne sde
eer tlate of app legal n�de owneR
D❑ Yes ❑ No
K mnred wiM someone other Ihan . indimte with whom
aeller (nwnDer antl streel, cdy, stare.
x holder of rtnrtga9e
saee4 �}: state, and Z/P cod )
Oces eppf"uaM axn property in any oNer
munry in Indiana? ❑ Yes
Drdu[aon apprwed in �he artpuni oY.
20_ 2�_
sig�tum af CamN nWilw
It yes.
�
Is U�e property in question: Mm�ally Ascesse0
��Rral Roperly ❑ Armually Assessed
0.1oW'le Flane (IC 61.
fw aurerv YPaY.',
COUNTYAU�ROR-
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zo _ J 1 lD CQ. ..�..
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I I We certi(y uMer ihe penaly of perjury Mat Ihe above aral (oregning infortnaGon is W e ai
owner I mntract buyer of the afwementioned P�nY on date applicalion is filed.
Sig'awre (owne/s IW reme)
� Fw� resiaeri(aed�ess d ava�t (numaer ana saeec dN, srate. ane z�aaoee)
5'�3 r, C�� � sf. oH -f�d,� s,v, y
Pesson aWaraed Ey d�dy esew�ed Power W Attm�eY w by IC G7.1-12-0.7
Mdress of authoraed person (number and street, dry, sfate. aM ZIP code)
!o
__ „� �u mat the applican[ is a resident of Irdiana aM
Date (monN, dey, yea�
ear rea�l