HomeMy WebLinkAboutMortgage_Bertramti
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
� FOR DEDUCTION FROM ASSESSED VALUATION
�• Stale Form 43709 (R11 / 6-09J
♦ d Presai0ed M OePartmeM of LoW Govemmeru Firenca
INSTRUCDONS: orp� p �t
To be filed in person or by mail with the Counry Audhor or Counry RecoNer o/ the cnunry where the pioperty is locafed. F mM� 3'1 Z � � �
Ftiirg Dates: 1) Real Property: Must file dunrg the year for which the deduclion is sought. n Counry Audimr
2J Mo6de / Manufadured Hanes rat assessed as Real Properly: Must file dunng the fweNe (12J months �{
befo�e Ma�ch 31 o/each year Ne deduction is mught. �LY �
See reverse side !a a�litional instnrcti�ons arM qualifications.
�,en
�Ma�m(ownerorcon rt�uyer-seerestricpo;sonrev�sitle) �� -. . ,
7f ro, what fs tus I her e� share of iniemsi?
11 name on remN is tlifierent Nan Nat of appOCant, indifate bebMc
D7ame ot rtnrtgagee «mnuxt se0er
Addtess of mort9agee or mntraG seller (numbar aM streef, crty, s
Name o( �ee w othei owner a halder a( `mrigage
Address of assignee (numbera� spae4 �: slNa. antl ZIP cade)
Dces aPplkant am propnny in any other If yes, wh
oouruy m Ind'ana? ❑ Yes
❑ No
Draumon apprwad in ihe amount of.
20 20 20
� / �
npaid as of M
�.7T..ul:�I
I:.7'•_•'�
uWebtedrress �mpaid as of I Is Ne appfmani Ne sale
legal w equlbde amefl
❑ Ye5 ❑ No
han spouse, iM1cate wtth Mwm
Is ihe property in puestion: MnuaOy Assessed
] Rea� amxrtr ❑ /��r �
Moble Fiome fIC G7.
,�e� ��► �A�y �. -
s U's deduoirn been reQUwted m propcty
artem yra(� ❑ Ves ❑
aoll- �fl
LU
20 I 20
I I We cerofy under Ne penalty of perjury that Ne above and foregoing infortnation is true and cortect aM that Ne applinnt is a resident of Indiana aM
rqmer I contracl buyer of the aforemeMioned property on date applicaCon is filed.
�re, arb
�
Person auNOmetl Oy duy exewteE Power o( AttomeY w Cy IC 61.1-12-0.7 I.Date (mont6 day yea� — '-
�re.