HomeMy WebLinkAboutMortgage_Bartley"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS oun ___ Township Year
,_ = FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R71 / 6-09)
�' Presuibetl by Department of Local GovemmeN Firence
File Mark
INS7RUCTlONS: S E P F^,rm
To be filed in person o/ by mail wiN the County Auditor or Counry Recorder o( the county where the property is located.
F7ing Dates: 1J Real Property: Must 6)e durirg the year /or which the deduction is sought � Counry Auditw
2) Mo6ile / Manufactwed Homes rrot assessed as Real Property: Must file dunng the fwelve (72/ mont��a litst _. ��ry Remrder
6e(ore Ma2h 37 0/ each year the deduction is sayht "" L7"'
See ieverse side fm additional instruclFons and qualifications. _ G�BSON CO OR
ed vaWe d4ral property as of
1, anent year
what ts his / her eraC share of inreBSt?
legal EcsaiDtim
Mortyage / Contraa intle6ledness
March 1, airtefrt ym� _
H nazne on 2coid is EiSe2nt Nan Nat o( aOP�t
., . � •-.r .r�".:z�
3
Pddress of rtart9� or contrad se0er (n�unbu aM svee4 uN. state. ard ZIP code)
rvame ot assgnee or omer owner or naaer rn mortgage
AdCress ot assignee (number aM stree; rdy, s1Ete, and ZIP
Dr�uction
20
-c�G
Mortgage I Cono-act inEebtedn�s
data of appikation
f with sortieme other ihan spouu. i
Is ll�e prt
propercy in any oNer I If yrs, whal counl�? I What Tarinc
❑ Yes ❑ No
�� '� — COUNTYAUDROR
in'the artwum ot
20 20 _ 20 _
unpaitl as ol Is t�e applpnt Ne sole
legal or epuiHN¢ amM
❑ Yes ❑ No
idinte Wnh wtwm
perry in Oucstiwc MnuaDyASSessed
�oaenr ❑n�aMa�s�sed
��...��..... _
Dra��'er i
. . :��1 � �'.. ..... -
Card ND• •' �
m
� 1�`?��Sd-? � _ _ - - 1 �
�
r�
Date (nrmth. daY. Y��
20
I I We certify u�er �he penatty of perjury Ihat the above arW (oregoing infortnaUon is We and corteG ard that the applirant is a resident of Indiana aM
owner I contrad buyer of ihe aforementloned property on date appliration is filed.
Full tlenl6Adkssofappli�nt(numDerantlstreet,cN};/s�are,�and/ZlPa/otlIe) /J _/
� 9iY�� �a�t s-fwfe �•J /o)� Ch��+�C� ���Y T�V y%�i�
Persori autM�aetl Ey duty executed Poxer olAttm�ey rn by IC 61.1-12-0.7
P4tlress of authorhed persan (number e� sbee; crly, sfafe, arM ZIP mtle) .
Date (monih.