HomeMy WebLinkAboutMortgage_Baker (4)^•+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
� FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fortn 43709 (R71 / 6-09)
,' � P2svibetl by Departmerit af Laal Govemment Fi�
INSTRUCT70NS:
To 6e (led in person w by mail with Ne CountyAuditor or Counry Recorder o! the counry where the property is locat .
Filirg Dates: 7) Real Pmperty: Musf fde during the year for which the deduction is soughf.
2) Mobile / Manufactured Homes not assessed as Real Property Must file dunng fhe fweHe (12) months
6efae March 37 oJeach year the deductinn is sougA[.
See reverse side forpQdtional insVUCtions and qualifications.
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7- - in - numbe l�g-1 O�UOn 1 IO ^_ r w_• r� �p ^�� r Paye num
y�� ��� � � i: 3
vahie d� prope,rty as af Mortgage / ContraG iMe6letlnes5 unpaid as W Mwigage I ConTU1 mtlebteCrress u�paiE as d Is Ne appG�ant Ne sole
MaRh i. amM year Mart� t. ai nt yeer datc of appGcation legal a epuBade ame(.+
❑ Yes ❑ No
If m. what ts his / her erM shara of inte�est? If rnmetl with sortieone dher than spouse. irM�imte wflh whom
If name on Rmid'a dMerent Nan �hat of applkant, 'vidirate bebw. Is tlie property in Qurstion: Mnualy AssesseE
❑ Real Property ❑ ArmualyAssessed
Nama ot rtart929ee or contract seller
Address W mortgagee u mntrae sn�er (number an et �y: arrtl �JwQe� +,,,=-
�/� t.r�'/r I wblL.(A.-J
Name al assignee w oNer owner or holder W mortgage
Addrass of assignee (number aM stree; tlry. state, aM ZIP mCe) ��
Does e�piita�4 own properry in any olhu s q
�„�r�����a ❑ v� ❑ r,o Dran�ei• NO..�/..........
c��-� �io 3�a� .
Has Na detluOim Deen reQueSteO m ptoperty
tor mnene yraR ❑ ves ❑ No
DeducCOn aGW� in Me artaunt aF. • . • . • • • i • • • • • • • • • . • • • • • •
��1 $�.�9
zo 2o zo zo
Sig�nue d CambAUOitnr Counry Date (mmlh, daY. Y��
I I We certify u�er the penalry of peryury that the above and toregoing intortnalion is We and cortecl and that the applirant is a resident of Indiana arM
owner I contract buyer of Ne aforeme�oned property on date application is filed.
Si9nawfg.(o�me/s futl �rtre) ... .. Date (mondi. daY. Y�A
riry, srate, and zrr
Date (monih. daY. Y��
auNa¢ed person (numberaM sbee4 aN. ��. antl LP code)