HomeMy WebLinkAboutMortgage_Barthel^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hi ar
__ _ s FOR DEDUCTION FROM ASSESSED VALUATION
� • State Form 43709 (R71 / 6-09)
S f Presaibed by DeR�M o( Loml Govemment Fumt�x
�JSTRUCTIONS: ��
Form f�ed with:
To 6e frled in person w by mail witA the CountyAUditw or Counry ReooNer o( the county where the pioperty is located.
Fitirtg Dates: 7/ Real Property: Must file dunng Ihe year for which the deductlon is sought. ditnr
2) Mob�7e / Manufactured Homes iwt assessed as Real Property: Must file dunng the Kvelve (72) montAs
before March 37 o(each year the deduction is sought GIB ON UNT ef
See reverse sidejor'9d�ytionel insUUCtions anQ quali�catlons. - ----
n �istrifY KeY �
O rahie d rnal PW�Y as d
M2rd� 1. aamvYear
1( Iq. Wlld� IS M! Mf B%dCf 5113R 0( If11Pl¢SY7
If name m recad a SAfuent than Nat of appi
Name of rtqrtgagee or cmtrac� se�er
desaiDtim
ia- 07-
Ie / CA�tWpt'uWd
��
Addrea of rtart9agee ar cmtraG sWer (num6er and StreeG ciry, sta�.
Nama of assignea w othar owner w halder of mort�age
MGress ot assignce (numOeraM street ary, sfate, anc
Dces epplitant wm pmperty in any oNu
`��h��l��� ❑ Yes ❑ No
'
DeduGion ePP�� m the amaunt oF:
20 n1_
what wunty7
20 _
1 I We certify urWer Ne penalry ot perjuMQ�at ihe above a
owner I conhacl buyer ot the afotemenLOi�ed property on
' nanue (amre
�anly�pa of appfrcant (numb( �arM sbect, tity, state, arc
IU S Ma�v. F'C�,n(,�{ir �
PMSOn auUpRetl by tluty executeC 7awer oi MtomeY � bY IC Ft.'
RemN mm�be�
)d-oo�.3do -Od
s unpaid a, d Mortgage I Contrarl indebteMess impaid as W
O � Cate of ePP���,�\
If awr�ed vriN someorie atF � hd'�mte with wt�c
a equ(bde wndl
� Yes ❑ No
�+:on: Mm��' Assessed
, �a'��,.f� . � � ��
m�
C'g�. � �
d��,O � ' �/�
_ • �'•. �(�C .
`'� /7� 6.
F1as Uus Mtlutlion Deen� �
/or amMLL Yea(.� � Yes
.y
, No
20 � 20 _ � 20 _ I n1 _
regning intamation is we and cortecl and that Me appii�ant is a resident of IMiana aM
appiication is filed.
Date (rtimfi. daY. Y8?�)
person (num6erarMSVee;city,5ta(e,aMZlPCOde)
�r. r�