HomeMy WebLinkAboutMortgage_Blackburn (8)°^� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fartn 43709 (R8/ 2-07)
�' w„ � Presrnbed by DePanmenl d Local GavemmmY Fironce
INSTRUC710NS:
To be filed in person w by mad with the CourrtyAuditor o/ the couMy where tAe pmpe,ty is bcated.
Fding Dates: i) Real Proper[y During Ure 12 months be%re Jurre !7 W the year the deduction is to be e�lective. �P p q q 2009
2) Mobile Homes assessed'mder IC 6-1.1-7: Befiveen January 15 and March 2 of the year tl,e deduclion is to e/rec&ve"
See reverse side /a additional insWctions ard qualifications.
appliarn (owner ar wn buye - see resmclm reve jrd�j
_`Y�
i DisUiG K number / legal desaiption
a6- � •o - !�
Sssessed rdue aF real poperty as d March 1. ar�e`K Y�� ��9a
arterd ye
I'�hal is h's / her exaQ shara W inleresl?
If reme m recwd is Eifferent than 1ha1 of applicant in6wle helow:
Name o( mwtgagee or cmlraU seller �)
l �
hddresa m morlga9ce a oonuaa seller (rxmber an0 streeG dN• sfafe.
Name of axsgnee a ather owner w hdda u1 matg�qe
Address M assignee (rxrn6et aM sUeel, �
Doas applipM own praperty in arry olher
cauNy u� Indaral
❑Yes ❑No
Detluction appioved'm the amourit of:
20 �.p 20 _
/
SignaWre of CauntylwdAOr
az
Page rwmber
Is Ihe appGfanl ihe sde legal or equitahia ovrt�e(
❑Yes ❑No
Ir owred wEh sort�mne dher Ihan spouse.
Is �he poparty
❑ Real Prop
� �
\• i �
� �. ' r
❑ Modle Hare QC 61.
c�r cwn� ��7
� � W 1 � I I �
It yes, whel ca i ion been re9uestad on popeAy
�QO,GOI � 7 ❑Yes ❑No
r <�
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�_ ��• �� • _ Zo—
ronth, daY• YeaA
I/ We certify under the penalty oi perjury that the above and foregoing infomiation is We and correct and ihat the applicanLS was / were a residenl of
Indiana and owner of the aforementioned property on March t, 2b _
s6eet cdy, sfafe. an� LP
rutorney or br �c
person (numbeiand street dty. state, aM
�,,.�, s�iG ro
oa�e c�m. ear. r�d