HomeMy WebLinkAboutMortgage_Blume'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm 43709 (R71 / 609)
�` ,w / presoibeC by Department of Laal Govemment Firance
INSTRUCTIONS:
To be fi(ed in person w by mail vrith Me CounryAuditor or Counry Recorder o( Ne counry where fhe property is located.
Filirg Dates: 7) Real PropeRy: Must file d�nng fhe year fir which the deduclion is sought.
2) Mo6ile / Manufactured Homes not essesced as Real Praperty: Must file dunng the hvelve (72J months
6efore March 31 of each year the deducGOn is sought.
See reverse side additnonal instructions and qualficahons.
Appfuant(owrnr �crbuyer-seeresfictimnfpnmverLre�sitle) � �
Ta�dng DistruY
AsrsseE value d rnal paperty as ot
M�1 1. tlmgQ yYdr
If ro, what is his / her erad share o
If �wne on recad'a QAtuent fhan tt
�
I ! � i�
� � iJ^�QlJecorder
'L� �
AUDITOR
�_'- '. ._-"_ __ ____._____.___ _ _
ar Eate of aOP�� kgal or eQUhade wmdi
� ❑ Yes ❑ No
+' � If ovmed with mmeane other than spouse, indicate wilh whom
Is Ue OroPertY in 7uesUm: MnuaDy Assesse0
� Real Pfoperty Q Amvally A�sessed ...
mpr�gagee or mntraG uller � � � �
01 mortgageP w wntraG seller (nurtibrJ and stree; r8y, afa�, erd LP oode)
assignee w otlrer owner or hdCer W rtqrtgage ._ . — —
Adtlress o( assi9nee (number and stmeG dt}: stae,
amount oE
20 _ � 20 _
�. D f :111' C 1' �i � . . . .�.Y. I� . . . . ..
� 5 I`�'l
C:II'(7 \� . .....................
_ I n��p6D.(St�
20 20 _ 20 _
Fias �ha tleduclirn Eeen requestetl on pmperty
fw airent yeaR ❑ Yes ❑ N
20 _ 20 _
Inahae d Camty AuCitor I Counry � I Date (montt�. aaY. Y�h
I I We certify under the penalry of perjury that Ne above and foregoing infortnation is We and corteU and that the applirant is a resident of Indiana aM
I cantra buyer of Ne aforementioned property on date application is fileC. -
� aairerS hN �e) if Date (rtmth. daY. )ea�
prI(etlGress c(g�ilFant (number and sLeet ciry, state, antl LP ootle)
uNO�aeE by duty executed Power d Httortiey or by IC 61.1-12-0.7 Date (mmfh. daY. Y��
01 authartrtd person (num6er erM sbee; tiry, 5tate, an0 LP oode) .