HomeMy WebLinkAboutMortgage_Braun^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counf
_ � FOR DEDUCTION FROM ASSESSED VALUATION
• Stata form 43709 (R11/6-09)
�' wM � P2smbed DJ OeParimerd af Local Govemment Firarcc
WSTRUCTIONS:
To 6e fi(ed in person a by mail with the CountyAuditor or Counry Recorder o/ the counry where the property is located.
Fitirg Dates: 1) Real Property Must file dunng Ne year for which fhe deducfion is soughf.
2) Mo6ife /Manufectured Homes not assessed as Real Pruperty: Must file dunng the hvelve (72J months
befole March 31 01 each year fhe deduclion is sought.
See reverse side lor addrtional inshuctiwu and qualfications.
..�y Auditor
_Caunri Recorder
App�l� (o»nar o,/fontraG buyer- see 2sb�eOns m mv�rse sde� ... ,
// ,r „/La/„ ,.,,/ ///J.,�,�„ ) e n . OIB80N COUNTY
�.�.. -
A�ed vdue of real poperty as d Mwt�age / Contrat 4
Martli 1. av�ent 7� Ma�W t, airrent year
If tw, what is his I Mr e� share of interest?
If riartie m recud b GRfuent Nan Ihat of appGranf, cdinte Eelovr.
Nartre of rtrortgagee or
Address of nqrtga9ce or mntraU selier (numbm and streeG �'dy: sbte, ard 2
Name of assignea or other owner w htlder of mortgaga
Add�ess of assignee (nv:nber ared stree4 dry, slafe, and LP tode)
�
Ooes aPWi�anl arm proprJly in arry oNv I( Yes. what couniyl
munry in Indana? r-� .. r� ..
� as af hbrigage / G
date o( appGc
tt owned wiM someorre
AUDROR
/�� I legal or equitaWe oxneYl
� ❑ Yes ❑ No
spouse, Mdicate wtth wtrorn
�Is/try�e P�P�Y in questim: MnuaM Asessed
OLJ ^eal PmPenY ❑ %�!?u!alhl A�s� . . _
CS �XJ - Gl✓
as Ihc deduaion Oeen re9uestrd m 7ropenY
tar wrtent yeaR n Yes ❑ No
20 � 20 20 _ 20 _ 20 _
DCfl\1'C1' ��-.../....(...�.....
yuM / n J j( Counry Date (monm. daY. Yea�
. . 11/ U
I I Wi f� l,' /nl
C���\ O� �� �regoing infomutlon is W e and corteG arid ihat the applirant is a resident of Indiana ard
ownE 1� �� J(iLL. UV aGPlintion is filed.
N�4re lovmers rw �mnwr� � i n _ ' Date (rtronM, daY• Yaa�)
anESLee4
Puwn auNOmetl Ey duty
y73.?
G1.
0