HomeMy WebLinkAboutMortgage_Blackard (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
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FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm G3709 (R71 / 609) T���
S�u. � Pre5ai0ed by De7artmeN of Lacal Gwemment Rnante g i
Fiie Mark
�vsrRUCnoNS: �t F� q� �
To 6e filed in person w 6y mail with the CounryAuditor or Counry Reco/der o/ the county wl��Ch�r p�ri}�� located. �
Filirg Dates: 7) Real Property: Must file Curing the yrear /o� which the deduclion is sought Counry Auditor
2) Mobde / Manu/actured Homes rrot assessed as Real Propetly Must h7e dunng the��(j1) months
6efore March 31 of eech year the deduction is sought C. J. �' j� � ❑ Counry Recorder
Seereverse�
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, �Y ��o��il�—/d'-� �%l�t7• 9S3-D � � �
7 eeal pfopeM1y as of Mwtgage / Contraa intle6tedness unpaiA as N Mortgage / Contract "uWe6tedness unpaiG as
year Ma�U t. w ygep ,/OO date of appfi�ation
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Page
Yes U No
It no, wnat rs na / her e�ct share of mtemsi? If ovmeE wiN someone other Nan spouu, md�te wM wnom
If name m remC is drtluent lhan Nat o/ appBpn4 uNicate 6ebw: Is tM property in pursoon: Mfwelly Asarssed
' � ❑ Real ProPertY ❑ %!^^!!�1!�
Name of mwtgagee ar mntraa seDer
Atltlress of mMgagce or cantraa seA
Name o( assignee or..+"
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sbte.
unty�
De[ ....m of:
20 20 20
Sig�aW o .WiG ^
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I/ We cenify under ihe alty of perjury t the above and fo
owner I mnVact buyer of ihe aforementioned property on date I
fuoire (owie�t MI name)
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�/�I fesident address of appl'rant (numOe�aM sbeet. dry, sfafe, anE ZIP mde)
LJ �O � C. W d � n1 U� S �,
Persm authmse0 Oy Euy esewted Poner W Atlorrey or Cy IC 61.1-12-0.7
Pddress of autlmr¢ed person (number arM snee{ rjry, yate, antl Z!P mde)
lM�at Ta�dng OaftiU7 I Has Na detludian Oeen ^ueSteE m property
ror w�mt vPan
20 20 20 _ 20 _
Counry Date (monlh. daY Ypa�)
�
ig infortnation is We and cortect arW Nat ihe applirant is a resident of Indiana and
:�n is filed.
Da[e (rtDnlh. daY. Y��I
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