HomeMy WebLinkAboutMortgage_Brubaker (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou own � , ear
_ : FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R11 / 6-09)
�' PRSVibeO Dy DepartmeM o1 Lo�al GovemmelU Fuunce
1�
INSTRUCTIONS:
To be filed in person or 6y mail wifh the CountyAuditw or Counry Recorder o! the counry where the pmperty is located.
Fifing Dates: 1J Real Property Must file dunng Ne year for which the detluction is sought. u Witor
2) Mobde /ManuFactured Homes not assessed as Real Prt�perty Must file dunng Ne fwelve (12J mon�8S0 C�II1JT���
before March 31 ot each year the deducGOn is so�ghC �
See reve�- -"^ ��rldi�ional inst�uctions and qualficafions.
App5cant ��...Ll..r._.. � yer' _ mstrirmns m revzrse sideJlll�_�`T �U' ..� \
1� V
b1 1 1 YlT V� n�.—\ r e nCl �
�ying� � Key
r
�
csessed vdue af 2al p�aperty as of
2iU 7, armrt y'ar
no. wha� 5 his / her ezact shae ot infeJe
fwrie m remrtl's 6ftuent Nan ihat of a
ame of rtnri9apee « mnbact se0er
aaaress m
Name of assipiee w other owner or
a..�� - u �- � � - ��
Mongage / Contraa'uWebtetlness unpaitl as
MarCh 7, arteM yeet �
(n�r and snee4 �Y state. ard ZlP code)
li�nl ovm praperty in any ot�er
InOiana?
❑ Yes
mwtgaga
slate, aM ZIP catle)
If ye5. whal tount�t
Remrd mmi6a Page number
aDi� c�a
as unpaid az d Is Ne aOP�� �e sole
kgal or itade owfmfl
es ❑ No
3. rtiQple Wiih whom
property m quesfion: MnuaAy A�suud
�I Pfope�ty � Armually0.sse�ed
- C� �� �n-n�Z
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WhatTad�gDisG I�,`�•��O•��I1�����'
COUNTYAUDROR
De�uclim aGW� ui Ihe amourd of.
20 20 20 _ 20 20 20 20 _
Sig�uwre U Camb NWi1or Caunry Date (rnddh. daY Yee�
I I We certify under Ne penalry o( perjury that the above aM (oregning infortnalion is W e and corted a�M Na[ Ne appiitant is a resideni of Indiana aM
owner / mntract buyer of the aforementioneG property on date apD�icalion is filed.
� Signawre fs fiN name) Date (rmuh. daY. yea�
Ful reSiAem of applrcant (number ard street, tlry, stata, a !P ootle)
�11 \ • V -�'
P au1M('¢eO Dy A�dy exeatetl Porer dAttarneY a by IC Gt.1-12-0.7 oa'e (morvn. eay. yea�
Addrea d auUror¢etl pe„'..rn (num6er and street dy. sbte, and LPCOde) .