HomeMy WebLinkAboutMortgage_Blankenberger^�n STATEMENT OF MORTGAGE OR CO�
„ = FOR DEDUCTION FROM ASSESSED
� • State Fortn 03709 (R71 / 6-09)
�` ,�r 2 Preunbed bY DeOartment ot Lacal Govemment Frence p�
�,;r,M/•?�Y�3� 2��2
wsrRUCnoNS:
To be filed in person w by mail wiUr the County Audifor or County Recorder ot the wunty �, s located.
Fii'mg Dates: 1J Real Property: Must file during the year for whirh the deduction is sougrit.
2) Mobife / ManuFactured Homes rrot assessed as Real Property: Must file dunng fhe tw ths
before Maich 31 o/each yearthe deduclion is sough[. G���(j ITOR
See reverse side fa addifional insVUCf+ons arM qualfirations.
s��r�an� Inwrwr or mnvarl r- 2s4�'m� m reverse s4C) /1 VI � .
If ra. what is his / her exad share ot interesT!
If �me m �ecad "s 6Meirnt Nan Nat of aDW�^�• cidvate
'ame ot irotgagee or contrad seDU �
aeamss m mort�aaee «ooneaa seo« (numbet am sbeel
o( assignee
33 I 9-1 O I- 00�. " �-o a�
•/ Conpact indebtedness unpaid as af Mw�qage I Contract indebtedness
A�t�� O� tlateofappGption
�T
If ox�ned wiN someone oUer Ihan spouse, i
bewrc � � 0^
stare, aM
Ooes aPPncant own P�PertY,i°� 'iat munp?
munry in IrWiana?
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G�;a�°. • pNg�i
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�� ...,er Ne p nalty of pe ry Mat the above and ( �
ownei �,ntrad buy�rQf the atoremerrtioned property on da�
Fias
forc
AUDROR
File Mark
Form fBed with:
County Auditor
County Recorder
q¢mrd ru� f age numoer
� a36
unpaid as M Is Ne apd�t 1he sole
legal w equitable owne/!
❑ Yes ❑ No
,a�,�a ^wm`„�,
/ \
� �`on:MnuaMASSessed
\ AfifLL1211y ASSC..SCd
`:�Wle Hartie (IC 67.1-
WWPnY
20 _ 20 20 _ 20 _
CounN Date ( , d . Y�� 1
� �/ C/�
�tormation is We and cortec[ arM Nat the appiican[ is a resident of IMiana aM
ation is filed.
Date (rtmrrth. daY. Y��
5���,L[J�TQf�ST�7state+a� Z�Pm1��'iI `
V�a N
by duty executetl PorerW Aaomey rn Oy IC 61.1-12-0.7
r¢d person (numbrl aid sbect. dry, sb(e, and LP cotle)
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Date (monN. tlaY. Y��