HomeMy WebLinkAboutMortgage_Bittner (6)STATEMENT OF M0�7GAGE OR CONTRACT I D ��
"'" N EBTEDNESS Coun Township Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sta[e Fwm 43709 (R11 / G09)
�' ' Presaibetl M DeP�M of Laai GovemmaN Fu�axe
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INSTRUCTIONS:
To be filed in person or by mail wifh the CountyAuditor or County Recortler o/ the county where the pioperty is t F �
Filing Dates: 7J Real Propefly: M�st file durirg the year /or which Ne deduction is soughL Counry Auditor
zJ befo�e Mart � of each year the d� ctron is sou�h��Perty Must fife dunng the hvelve (72J month.T� C T � ��ounry Remder
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See �everse side (ur additional instructrons and qualifications.
Appl�t (owner orconvarl buyer _see restnrliou on rgverse sife)
ot Key nsnEer / legal tl ption�
alo - o - �o-od�, 9is -oa-
eE raWe o( mal prapaty as d Mortgage / Contrau irdehtetlr�s unpaiC as ot Mortgage / ContraG'udeM
1. armnt year Mata� 1 artenl yrar EatB o( appGtaiion
If no. whal ts his! Mr e�C share ot intrlest?
If name an remrd is CiRerent lhan that of appOCam, "v�Airate helow:
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Name of assigncre w otlm! owner or hdder of mort9age
aear�s or ay4�nee (rw_i��:
Dces appliraf . t ovm popeny in any o�her
counry in Ind'ana? r-� .. r
20 1 20
state. aM ZIP oode)
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If es,whatmunty?
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numEer Page numbrl
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Yes �J No
awrretl wiM someone ah� ihdn sPOUSe. hMkate Wih whom
�Is IM roV�Y in quesGm: MnuaMAssessetl
Real ProPenY ❑ M^!�M ��
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What Tadng Dis6 p l. a��� er � �••••a' S'� ....
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COl1NTYAUDROR �,����� ��•r��
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1/ We certify under the pena}ty of perjury (h�t the above and foregoing infortnalion is we and cortect arW Nat Ne applirant is a resident of Indiana arM
owner / contracl buyer of the aforemerrtioi�ed property on date appliration is filed.
' re (o !s IW reme) Date (morRh. daY. Y��
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Full 'Oen Uappf¢arit(nu raMStrce4tity,stafe,eretl2lP )
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Person authorrzed Oy duty executetl Power of Avorney w by IC 67.1-72-0.7 Date (rmnN. day, yxa�
IAddress o( autharrzeO pert.on (number aM shee; dry, sbte, ard LPfode) , I