HomeMy WebLinkAboutMortgage_Borchelt"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun , wns Year
__ � FOR DEDUCTION FROM ASSESSED VALUATION
� � State:artn43709(R71/6-09)
�„�. � Pr¢scriEetl by Departmenl of Laal Govemmenl France
wsrRUCnoNS: MA����•`�012
F fileE wflh:
To be lled in person w by mail with !he CouniyAuditor or Counry Recortler of the county where the pmperry is located. .�
Filing Dates: 1) Real Property: Must file dunng the year /or which the deducfion is sought. � un Audimr
2) Mo6i7e / Manulactured Homes rat assessed as Real Property: Must file dunng fhe twelve (12) months
C n eoorder
belo�e Maich 31 o(each yearthe deduction is sayht GIBSO C TY q'U ITOR
See reverse side for additional insfruclions arM qualifications.
qppf�ayt(/qnerarcontr�6uyer-seerasfi�asscyi�i `T`se�S''de) � � .. . � A �
TarirgDiSb'vl Keynu berllepaltleSrnV / aO' /� ' O�
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Ases.ed vWue Ureal MopertY az N Mortpa9e / Cantraa'uWebtetlness unpaid az N Mwtgage I CmbaC
Mach 7, �nent yPar Mard� 7, w�rent year tlate of appliration
G
If ro. what fs F� / her e�a share o( interest? H owned wi� somearie dher
I( �wre m mmN is dCferent �han that of aPP��l uNicate belrnr.
flame of morcgagee or mntract sNier
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Address of mort9a9ee w mntract sWer (nu aM s6
r� m as�y�� «wn�r ow�� a i,da� m�cqaya
AilCress of asvgnea (number eM s e,
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Oces epplimnt ovm property in ny other
wunrymind'ana? I"I .,__ fl .�_
DeducCOn
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Signature
amouN of.
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ee4 ciry, state. ardlZlPkode)
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COUNTYAUDROR
2� _ 2a _ 2�
Record numEer
as d Is Ne applirant Me sak
legal w equifahle ameYl
� ❑ Yes ❑ No
wiN whom
Is C�e ryoperty in Quesfion: MnuaDy Assessed
❑ Real ProPeKY ❑ �^!�Y �
�lnD
Di•a�vcr \'O.. ��`�.....
ca��a �To. .... aQ3.l.....
I/ We certify under ihe perralry of perjury ihat the above and foregoing intortnalion is We and cortecl and that the appifnnt is a residertt of IMiana ard
owner / conUact buyer of Ne aforemerrtioned property on da[e appiication is filed.
�„��� r„�h nii.u�re� .. _ � J� Date (�mah. eal: )eeA '
endZlP
� autho�rsedCydWyexetuted
person (number ard slree4 ary. stale. end LPCade)
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