HomeMy WebLinkAboutMortgage_Baehl^'� �ATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
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s FOR DEDUCTION FROM ASSESSED VALUATION
• State Form 43709 (R11 / 6-09)
�' � P2wibed by Depariment of Local GovemrtreN Frence
� Fi
INSTRUCTIONS: �v�pttnt�
70 6e fi7ed in person or by mail witA the CountyAUditw w Counry Recwder of Ne counry where the property is located. F11�� y Z� ��
Fiiing Dates: 7) Real Property: Must �le during the year /or which the tleduction is sought. � u L J �ounty Auditor
2) Mobile / ManufacNred Homes not assessed as Real Properry: Must file dunng the tweNe (72J monfhs
be/ore March 37 of each year Ne deduction is sought C. ecorde�
See reverse side for addifional instnictions end qualifications.
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INa�M 1, tllrtnt year
�i M, W�Idl6 �YS � iMl BIdf2 5�18f8 O( VI(ERSI�
If rame m Roord is Eilferent Nan that o( aOpGtant'uMic
%�dTE Of IMRBdgCC Of COf111JG� $Q�Cf
A
ACAfPSSOI(IIOfIg2�fC W COIIG3G 52OGf IlIWIIDMB/I(I58
Name af assignee w othel awner or hdder of morigage
AAA2ss of assi9nea (number aritl saee4 �Y, slate, and
�/� �G .
Dces epplirant wm p(operty in any oNer�
Yes LJ No
Deducoon approved'm the amount W:
20 _
Signature of Counry Audi�or
,�( - - 0 0/, .?7� 7 Do?S
/ Contrau intlebted�ss unPaid as o( Mw�qage I ConvaG
vrterrt year date of appfxation
�Y. sfate.aM
20 � 20 —
Is Me app�xant Ihe sde
le�l a eQUita6ie awreYt
❑ Yes ❑ No
tt ownad with someona dher than sooLse. i�dirate with whom
�IS P�PQnYi(14UCSOOII:MMI2MASt55Cd
E2�PIOpB1(� �AfII.11l2�!�i�SE�
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Whal Ta�drg Distria?
COUNTYAUDROR
20 20
Counry
� �_33��
20 — � 20
Da4: (month. daY. Yea�
I/ We ceRify under the penalty of perjury Mat Ne above arW (oregoing infortnation is we and correct and Na[ ihe applican[ is a resident of Indiana aM
owner / contract buyer of the afaementioned property o� date applicalion is filed.
�naWre owneh /ytl reme) /1 , /] Dale (mon�h. daY. Yaa/)
� Full residenTatltlres W
a
artl sLeef, dl}; sfate, and ZIP code)
person (Aumber aM SbeeL dly. state, and LP mEe)
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