HomeMy WebLinkAboutMortgage_Blankenberger STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES" Efl SI�i•ship Year
v„, FOR DEDUCTION FROM ASSESSED VALUATION -
..c. t' State Form 43709(R11/6-09)
"- Prescribed by Department of Loral Government Finance
OEC 5 Z11. ileMark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is tea: F Ned
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. �6r�d,�1� oths County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the tUl[SJV V rt U NTY A w O
before March 31 of each year the deduction is sought �unry Recorder
See reverse side for additional instructions and qualifications.
AppliR(owner or l- - -,i .
Ta ' Key /legal description / Record number Page number
C-�224 a6-/a- .36 -vvoco /. /69 - 00 y 13 63av .
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the apprrant the sole
March 1,anent year March 1,current year --\\ I date of appfxation legal or equitable owner?
/X/ O IC°V ❑ Yes ❑ No
It no,what is his/her exact share of interest? a owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: ,Iss the property in question:Annually Assessed
1 71.iceal Property ❑Annually Assessed
T I Mobile Home(IC 6-1.1-7)
Name rortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
I
Address of assignee(number and street city,state,and: Ky4 id /3LA/ )KE7J i
Does applicant own property in any other I J3 n I n n/7' �K(-f�I Has this deduction been requested on properly
musty in Indiana? e -OG / for arnent year?
❑ Yes ❑ No I ❑ yes ❑ No
Deduction approved in the amount of. •
20 20 20 20 20 20 20
Signature of County Auditor - County 1 Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the epplirant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Date(month,day,year)
!z/r/z®/3
Full 1•-nt ad dne6vbl appf t(number and sheet.dry,state,and ZIP code) 1
•. authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,may;state,and VP code) 1