HomeMy WebLinkAboutMortgage_Blackardry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un Township Year
:__„ s FOR DEDUCTION FROM ASSESSED VALUATION
• Siate Fwm 43709 (Rt t/ 6-09)
�' �� Presaibetl by DepartmeM oi ln�al Govemrtrenl Frence .
File Mark
wsmucnoNS: DE �
To be filed in person w by mail with fhe Counry Auditor or Counry Reco(der o/ Ne wunry where the pmperty is located.
Fi/ing Dates: i) Real Property: Must file during the year (or which the deduclion is sought. � Counry Auditor
2) Mo6Be / Manu/aCured Homes rat assessed as Real Property Must file dunrrg Ne twelve (72) months - nry Recordu
6efore Ma/ch 37 0/ each year the deducfion is sought.
See reverse side for additional insUUCtions and qualifica(ions. 418$ON Y A ITOR
Aoo�xaM (oanerorcontraC buyer r�phir'dons m reverse side)
1 rdnre � real p'aperty a
aRPnt year
If ro, what ¢ his / her e�mr� share ot inteJesY!
artent year
If name on femtd 6 drtlerent Nan Nat of appBCant'o�dirate heb�r.
Nama ot �mrt�agee or
ot contracl seller (num6er aM s0ee( crty, sfafe, aM ZIP code)
or ot�n awner rn hdder ot mortgage
Mtlr�s ot assignee (number arM slree4 �Y. �fe. aM Z/P cotle)
Oces e�imnt oun yopnrty in any oNer
county in Ind'aria? r� ..
20 I 20
�6-oa�
az ot Mangage I G
Cate of auDfrc
Record numDer Page numOri
�00 (o�d�
imDaid as of Is Ne eCP��t the sole
legal a eWitaWe wmefl
❑ Yes ❑ No
If ovmed wiN someone other ihan spouse, iMirate with whom
COUNTYAUDROR
20 20 _
Caunry
i5 IM P�7ertY in QueStion: MmiellY Assessed
❑ Real P'vperty ❑ Mnualy Assessed
v���„-��-.io.....�:ooq......
�a��d .�o. .....�aa .y.
� 5Z��9�• �
20 _ � 20 _ � 20
Date (rtpnM, day,
I I We ceRify u r ihe penalry of pe�ry thai the a6ove ard foregoing infortnation is We and mrtect arM ihat ihe app(u2nt is a resident of Indiana aM
owner / contra buyer of the afaementioned pmperry on date ap0����n is filed. ,
7 ra (owne hA 1 _�`��'t-!L4/-v Date (monfi. daY• Y��
��A �� �� �� �
I�tlent of aoo nt (number and 5treeG dN, s+ate, aM Z1P cotla) � �
%�r% L l/,l/I�-i� �l� f .
Pem.on auUwfved Dy dNy ese�teG Power al Atmrt�ey w Dy
��
person (number aM sbeet, cNy, state, an0 LP code) . I
/Y