HomeMy WebLinkAboutMortgage_Bradshaw"�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTED�S Coun Township Year
= FOR DEDUCTION FROM ASSESSED V����
7r°_ . " State Fortn 43709 (R11 / 6-09)
t F P��p� py pepartmenl af Loral Govemment Fnance
File Mark
�STRUCTIONS: 'ZQ�Z,
,'^V Fortn filed wiN:
To be filed in person of by mail with the Counry Auditor or Counry Recorder of dN�bu where the p�operty is kcated. I,_,,�,
Filing Dates: 1 J Real Pmperfy: Must file during fhe yrear for which tbe deduc6on i �soug6tn-� � Counry Auditor
2) Mo6r7e / Manufactured Nomes rwt assessed as Real Property3lust�Y�f��na thii fwelve (12) months
before March 37 0/ eacA year the deducfion is sayht. � v Counry Recorder
Searavarsesideforad�jiljonalinsVUCtionsarMqyalificatrons. ,,,ac(1NCOUNTYAUDIT�� \
T� p' 'a KeY wmber / legal desaiPtion
� -/
avdn,ea r�aov&•y�m �9e� �
A/a�N 1. aarenl Year �• p
aN
If ra, �Mat Is his ! her e�ract share of interest?
It name m�emrd is EiReran than that ol appticanL hidirate bebw
Nartre N mwnJa9ee or cmtracl setler �
ncdrPSS ot rtwrc�a5ee «mntraa smer (mmt�er era sbael <N: sran
ranty
F.7
�9��
\ �/ Recortl rw Pege nu
- a�!-0 cD•O S�c�.b ld- l�`
dehtedness unpaid a of Marigage / ConVaG'uMebtetlness unpaid a d b Ne app�ont Ne sde
tlate of apP���� kgal w eQUitade ameY.+
S O ❑ Yes ❑ No
If owned wiN someone oNer ttan spouse, iMicate wilh wlrom
Is the pmperty in QuesUm: Mnuelly Assessed
❑ Real PropeAy ❑ Mnually Assessed
�
�,nee or dher ownn or haldg d mortBa9e
si9nee lnumtw..�.•w -'-- .— ' _" —
_ �s,� � �
aoi a........
D,�a„ ��� �o........
GOUNTY
l 3 ��1.......
c��-� �o. .........
20
Counry
i�
,���
�, ��
��
I I We certify urder the penalry oi perjury Ihat the above and foregoing infortnatlon is true and
owner % conVad buyer oi ihe aforementioned property on date application is filed.
(numDer an0 sLeet, tlty, sfate,
PrJSOn authonied by duy ezecuted Prnwer af Atlort�ey w by IC 61.7-12-0.7
Atldress of authwrzEd person (numbe� aM sbee4 pN. stale. aM Z!P oode)
�tlim Eeen requwtn
��
%
z�Date (rtanN, daY• l�A
on prope+ty
❑ No
20 _
aM that the applicant is a resident ot Indiana aM
Date
yea�