HomeMy WebLinkAboutMortgage_Baker^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION
. . • State Fortn 43709 (R71 / 6-09)
, l Prewibetl q' Departrtrent o( L.oml Gwemment Firence
a
INSTRUCTIONS:
To be filed in person or by mail with the County Auditof or Counry Recorder o7 the counry wheie the property is located. �� (�
F�ing Dates: i) Real Property: Musf file durirg the year for which the deduction is wughL � Co�nOry'7(uditw
2) Mobile / ManWectured Homes not assessed as Real Property: Must file dunng the hveNe (12J months
6ePore MamJr 37 of each yenr the deduction is mughL ❑ County Remrder
a�., ,�S
See reverse side for addrtional instruUions arM quali�cations.
MP���(o�+4���^�buyer-s�mstrirbonsmreverseside) .-� � � ITOF
Oistrict
A 2a� PmDenY as
�
ro, what is ha / her araG share of interest?
arte�rt yeer
nazne m remd's 6Rerent Nan Ihat Of aPP�•'uWitaOe Eebw.
owner or hdder of rtpr�gage
- 1 /1 " Uei.'t— Uel C) �
de6teEness unpai0 az W MMgaqe / Con�aa uMebfeEness unpaiO as d Is Ne
date of appfi�ation legal
If wmed wkh sameone other than spouse, iMimte with whom
5fa�. aM ZIP code)
(number aM stree4 �y, slele, end ZIP oo0e)
Dces e�i�nt wm p(opercy in any other
counry m IndFana? n .,_ _
amount oF
20 _ 20 _
Signature of CounN Audimr
If yes. what caunry? I Wt�at Tavr
COUNTYAUDROR
20_ 2�_
Counry
ovme(?
n No
P�Oe+b in OueStion: MnuaM Assessed
eal Property Q lvmuaPj AssesSed
Mobile Fbme (IC 61.
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vaie (moNh.
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I I We certlfy under the penalty of perjury that Ne above and foregoing intortnalion is We and mrtect arM ihat Ne appfirant is a resident of Indiana aM
owner I mntrad buyer ot �he afwementianed property on date appiication is filed.
�naWr e/sNOrame) Data(,mrd4daY.Y��)
'c�������
'� t aEtlress W appGdnt (numDer antl sbec4 aN. s+ae, antl ZIP cotle)" ' _ " ''_ "' _
Dy duly ezewteC Powef
Atltlmss of auihor'¢eE person
rc by IC G7.1-12-0]
state, enG ZIP cade)
Date (rtronN. Oay. yaa�
i
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