HomeMy WebLinkAboutMortgage_Behrman (2)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ s FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fortn 43709 (R71 / 6-09)
�` Presoibed Ey DepartmeM of Local Govemment Fu�ance
INSTRUCTIONS:
To be filed in person or 6y mail wdh Ihe CountyAUditor or Counry Recortler oI the county where the property is located. F�
Fifing Dates: 1) Real Properry: Must file durirg the year /or which Ne tleduction is sought.
2) Mobr7e / ManuFactured Homes not assessed as Real Property: Musf file during the fweNe (12J rtronths C
6efora Mardr 37 0! each year the deducfion is souyht.
See reverse side for additbnal instrvct;ons arM qualiflcations. �� �� �,
•+ _ (f�!
Mortpage / Contract Inde6teCness
March 1, Wrtentyear
If no, what's his / her exaG share of interest?
tt name m record is dAfuent Ihan that of aPP�6 �ipte below.
Name of mort9a9� w conbact
Seller (num6e/eM StrBe4 �Y. sfate. eM ZIP code)
assignee w ahu owner or holder ot mMgage
AAtlress of assignee (num6er aM afree4 �K}: s7a1e, and Z/P coda)
Does applimnt own P�PenY
counry in IMena? r
as W I M«tnaae /
as d Is Ne aPd�l Ne sde
kgal w eQuirade ownefl
❑ Yes ❑ No
If ovmed wiN mmeorre other ihan spouse. iMNate wiTh xAwm
Is Ihe PmPertY in vuestian: Mnuelly Assesse0
�Real ProPeM ❑ Armuaily AssesSed
�uaion been re9urste0 m p�operty
COUNTYAUDROR �O I �
AuUan appmved in tl�e amount of. D r a�r' �,' I� � �.........
20 20 20 20 _ 20 _ "'� /`� /
Card NO ./}.p.... .\ ...........
yawre W CoimN AudP,w �IX1"�' I/ j// �VI/. (�CJ
"I
I/ We certify under Ne penalry of perjury that the above antl foregoing information is We and cortec[ a�M that the apptirant is a resident of Indiana and
owner I contract buyer of ihe afore rttioned pmperty on date applicatlon is filed.
]na� (ownef� fiAI name) n Date (rtmfh. daY. Y��
Pawn auNO�aed Oy dWy executetl Power of AlOOmey w by IC 67.1-12-0.]
Pddress of aNhwaed person (numDer aM sUeeL ciry, sYdfe, aM ➢P code)
Date (manfh. daY. Y��
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