HomeMy WebLinkAboutMortgage_BlankenbergerSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
- FOR DEDUCTION FROM ASSESSED VALUATION
\ � State Fortn 43709 (R3 / 10-00)
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_� PreWibetl M State Boaid o1 Tax CortunissiotKrs
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InsUvctionsforfiling:
To be filed in person or by mail with the Counry Auditor of the county where the property is
located during the 12 morrths before May 17 of the year the dedudion is,to be effedive. See
reverse side for additional insWdions and qualifications.
Applipnt (ownerorcontract buyer- ee restrictions ori revers side)
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Taxing isfid Key number / legal description
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AUG 31 Z001
number
FORM 5
Year
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Assessed v u of real prope as oi Mortgage / Cantrad indebtedness unpaid as of Is the applipnt the sole legal or equitable
March 1, nt year _ March 1, current year , owneR ❑ Yes ❑ No '
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If no, what is his / her exact share of interest? If owned with someone other than spouse, indicate with whom.
If name on record is different than thal of applicant, indicate below:
or contraG seller � �
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Address of mortgagee or contract seller (number and street, city,
of assignee or other owner or holder of mortgage
of assignee (numbe� and street, dty. state, ZIP code)
Does applicant own real property in any If yes, what wunty?
other county in Indiana?
amount
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ZIP
What Taxing Distrid?
COUNTY AUDITOR
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County Auditor �-
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Has this dedudion been requested on
property for current yeaR � Yes❑ No
20 ,� , I 20 �
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ve certify under the penalty of perjury that lhe above and foregoing infortnatlon is We and correcl and that the applicants was / were
�ident of Indiana and owner of the aforementioned property on March 1, 20
ature (owners Iull name) Person authorized by duly executed Power of Attomey
�� / /�� ��a� or by IC 61.1-12-.07
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resident address o applicant Addreu of author¢ed person