HomeMy WebLinkAboutMortgage_Baehl-�'�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
�'; FOR DEDUCTION FROM ASSESSED VALUATION -
S, State Form 43709 (R11 / 6-09)
� Presaibed by DepaNnent of Locel Govemment Finance
INSTftUCT10N5:
To 6e filed in person or by mail.
Filing Dafes: 1J Real Property: Must be completed and dated in the calendar year7or which the detlucfion is sought.
Musf be filed with fhe County AudifOr or County Recorder o/ the caunty where the plopeRy is locafed
on or 6e/ore January 5 0l lhe immetliatety succaeding calendar year.
2) Mo6ile /Manulactured Homes no( assessed as Real Property: Musf file wifh the CountyAuditor olthe
county where fhe p/operty is locafed dunng the M1velve (72J months before March 31 of each year th�16
deducfion is sought.
See `everse side (or additional instiuctions and qualifications.
Appfi�'ant (owxr or cmbacr buye� - see resvicGons rn reverse side)
ERIC A. BAEHL
AcsessEd vahie W real O�PenY as
h7arch 1. aurent year
It no, what is Ns / her ezaq share
I( name on reco�d is Oi.'.erent Nan
Name of rtwrtgagea w conUatl si
�i,ER.�€csrzrset�
AEtlress of prtrovrtgagee w convact
�^ 00 �
Name of assignee or oNer owner
inscrunent
Instrument
2012000D4471
Auditor
Key num0er / legal tlesmiptirn Rem num0er Page number
2E79-19-203-001.268-026 Z � �
Mortgage / Contraa indebtetlness unpaid as of Mortgage / CanuaG indebteAness unpaitl as ot Is Ihe appGCant Ne sde
March 1, artent year date of appGcation legal ar equitable wmeY!
,,,,�00 o Ye5 ❑ No
leresl? If ormeC vnN mmeone oNer fhan spouse, inCira[e wiN wtwm
of apptinnt, iMiwte Eebw. Is Ne pmperty in question: MnuaOy PssesseE
❑� Real Property ❑ MnualyASSessed
Mobile Home (IC 6-iJ-7
Dces aDD���nt ovm property in any other
counry in Ind'ana?
❑ Yes
i�
�h��
sta[e. and Z/P cade)
If yes, what counry7 I What Tasing Oistna4 I Has Nis deduction been reQUesteO on Omperty
forwrtentyeaY? � _ � ,
COUNTYAUDROR
�eduction approveC in iha artwum of:
20 _ 20 _ 20 _ 20 20 _ 20 20
Syna;ure of CounyAUtli�r Gaunry . Date (monN. tlay, yea�
I/ We certify under the Oenalty of pe�ury thai the above and foregoing infortnation is We and wrtect and that the apP���nt is a resident of Indiana and
owner / conVact buyer of Ihe aforementioned property on date application is filed.
Signa:ure (rnme�s fWl name) Date (monN. day. yea�
�� A �y osi�jzotz
FW resident address ol applrtant (numEer aiM sfreet dty, sfate, aM ZIP cntle)
259 E 795 S FT BRANCH IN 47648
Person authorized by Ouy execut¢tl Power ol Momey or Oy IC 61 J42-0.7 Date (monfh. day. yea�
Addrew ot autlwrrzad person (number antl sbeet, ciry, sfafe, ab ZIP cnde)
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