HomeMy WebLinkAboutMortgage_BLW"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
:r'_'
FOR DEDUCTION FROM ASSESSED VALUATION
- � State Fwm 43709 (R71 / 6-09)
`' ,w Resaibetl 4Y DePartrtle�H of Wcal GovemmeM Frence
� '
NsraucnoNS:
�To be filed in person w 6y mail with the CounryAUdRw or Counry Recorder o! the counry where the property is 1 ted. F
Fi7ing Dates: 1) Real Pmperry: Must file durirg the yearlor which the deduction is sought. County Auditor
2) Mo6de / Manu/actu�ed Homes nof essessed as Real PropeRy: Must hie dunng the hvelve (12) month� EB 1 � ��unty Recorder
befae Maich 37 0! each year the deducdon is sou�ht.
See ieverse side (or additional insfruc(nons and quelifications.
�. Ap�rant (owner cantra y+er - see ie ve sitle)
Ta � /�I��� "1 �aO�( �
[ �� \
Marh t� m�entd real qoperty as o( I Mor[uage / Contracl'vdehtedn�s unPaitl as af
yrar Mamf� t. airtent yaa. �
e�2
It �wne on recutl is 6flerent than Ihat U aPW��l• uWirate below:
Name ot rtqrtgagea or varl seller
Address d rtnryagee or wntraa seAer (nurtiber et c+N. si
Name ot assignee or ofher ovmer ar Mitler oi rtprtgage
Address of assig�e (num6er aM sveet a1y. sla+e, antl Z/P cotle)
Oces applinM own pmperty in any olher It yes, what wunry?
county m Ind'ana?
❑ Yes ❑ No
C.�.
someone other Ihan spouse.
numCU �Pagenumb�
as o( I Is the appGrant Ihe sde
Iegal p epuitade ame(?
1'ht1��iCi
I5 tl�e ProD�Y in Ouestion: MnuallY Assesud
❑ Real Property ❑ Mnually Assessed
MoWle Hm�e fIC 6
_�a7�r fn1 :�
cla ogol
Whal Tawg Distrifl? I Has N�s detludian Ceen requesteE rn property
(or a�rtent yraR
❑ Yes ❑ No
COUNTYAUDROR
" DeducUOn app�oved'm tlre amoum of:
20 20 _ 20 20 20 20 _ 20
syrawre or co„oy a,aaor ca,�H oace (�vn. dar. r��1
I I We certify untler �he penalry of pefjury Nat the above aM foregoing informalion is We and cortect and Nat Me applicant is a resident o( Irdiaria aM
amer I contrad buyer of the atoremertboned pmperty on da[e applinbon is filed.
' nature (owne !WI reme) Date (nmM. daY. Yaah
FW resitlent o(applifant(numDerandsLee[crty.5fate,andLPOOde)
60iS � Du. � J: c.� T�J ?C�
authar¢ed Ey dWy ezewted Power of Attor�y w by IC G7.1-12-0.7 Date (monm. tlay. yea�
Pdtlress of authoraed person (numberarb sVe�f. ci1y. stafe. anU ZIP aotle) _