HomeMy WebLinkAboutMortgage_Blankenberger (3)�^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
,_ FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Fortn 43709 (R11 / 6-09)
S � Preuribed by DePa���� of Laml GwemmeN Friance
� File Ma
INSTRUCTIONS:
To be filed in person w by mail vnth the Co�ntyAud'ROr or County Recorder o/ the county where fhe property is located. h�
Filirrg Dates: 7) Real Pmperty: Musf fJe during the year for which the deduction is sought. ry Audimr
2J Mobile / Manufadured Homes not assessed as Real Prtiperty Must fi!e dunng the tweNe (12) months � y--�
be(ae Ma/cA 31 of each year the deduction is sougAt LJ o n eowder
See reverse side foradditional instrucGOns and qualifications. GIBSON COUNTY AUDITOR
1raWedrealP�W�Yaaof
ammt year
no, xfiat's his I her exafl share ot interest?
-/5' y io�- oao. � -oa �
Abr[qage / CantraG "vitlebteO�ss unP� as of Mw�qaga / Contrx
Marrh 7, airtent year tlate of appRCation
11 iwrre m rt.md it EiHerent than ihai of app5tant, uWirace belaw:
Name of mortc�agee or
Adtlress oi rtnrtga9ce
w other owner w holder of rturtgage
of acsi9nee (number arM street �Y. �te, and Z/P
Does appFmnt own propeny in any oNer
county in Irid'ana? n .,_ _
20
Sig'aLL�re
� � �
fily, state. aM ZIP pode)
I I We certiry undei Ne De alty of perjury Nat the abov[
�� r I onV� buye t e o men �oned property on
wn na )
• I
��
U fesident a0tlrass ol appGqnt (num r an0 sLect ; state, ax
Soo S. �
rson aufhor'¢N Cy ONI' ezecuted Pw�er of AttaneY or by IC G7.'
Address of autha'vcd per..on (number and sbeef, dry, state, end ZIP code)
as d I Is Ne appfrcant Me sde
legal w equipble awndi
❑ Yes ❑ No
If wmed with someone oNer than soouse. ir�dicate wmh whom
is filed.
2a
a�m m a�,�nw,: anm,aM r�ssessea
�I ProPertY ❑ Armually Assessed
�3�aNk�u a ���n,
T ,vA-T+�M� �
Id -d5�o
Date (rtmUi. daY. Yea�
We and correct and ihat the applinnt is a resident of I�iana aM
Date (rtimth. daY. Y�s�)
� Oate (month, deY. Year) -