HomeMy WebLinkAboutMortgage_Boehman"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
�' f Presaibetl by Departrtrerd ol Laal GovemmeM Fu�ance
INSTRUCTIONS:
To 6e (Ied in person or by mail with the CounryAudhor or Counry Recorder o/ the counry where the pioperty is located.
Filirg Dates: 7) Real Pmperty: Must (la dudng fhe year for which the deduction is sought I
2) Mo6ile / Manufactu2d Homes irot assessed as Real Property: Mus! fife dunng the hvelve (12) months
befae March 37 oteacA yearthe deduction is sought.
Sea reverse side tor addtional insVUC(ions and qualrfications.
AppGCan ` ar or cont buyer � see 1a61nrtbns m reverse sitle
��� J GIBSON
GoW[�}y�,qyyditor
C4ounFyliecorder
T�u oLSfitl � Key ber I a�pU� �_ w_`• �' RCCOtE m Pa e n�pp� �
o�� 'ws �
Asessed rahe of real poperty as of Mor�qage / ContraG irde6letlness unpaid a o( Mwtgage / Contraa vWebted�ress unpaid az of is Ne app�irant the sok
Ma�rht,asre(rtyear Ma a t Cateo(appfi�atiwi legaloreQUdaWeowneYl
�� ❑ Yes ❑ No
If ro. what is Itis I her exact share o! interest? If owned vriN someone other Ihan spouse. i'dircate wah wtwm
If name on remtl'a drtfrlent Nan Nat of aDpOCanf, uMinte bebvr. Is ihe property in Quesfion: MrwaOy Assrssed
❑ Real Roperry ❑ Mnualy0.ssessed
of rtprtgagee or mntracl seDer (num6er end s�eL �N: stefe.
Name of assignee or oNer owner or hdder of rtqrtgage �
Mdress of assignce (number antl street, tlry, smte, antl ZIP
Ooes applipnt own property in eny other It ye
munry In Indiana?
❑ Yes ❑ No
Oetluction apyaved in Cre amounl oE
20 _
SigreWre dCounryAudt�cr
�
Dra��•er NO. °?�%........
Card NO. ..�..��.� .........
� cZa�O, �/� o ��
20 � 2Q _ � 20 _ � 20
as Nis tleCUClion Deen repue5leE m proprlly
V W�1Cl1� YP2(1 O
❑ Yes
2q � 20
I I We certify uMer the penalry of perjury that the above arW foregning informalion is We and cortect arM iha[ ihe applirant is a resident of Indiana arW
/ wntra�Y buyer of Ne afo2meMioned property on date appliqtion is filed.
ri(owne(s fiNname) Data (nrnCi. daY•Y�A
d appfiont (number and sheeG tlry, slate,
M
P4dre55 of authw'v.ed person (number aiM SLee; riry, sYdfe, and LP cotle)
Date (monN. tlaY..Y��) _