HomeMy WebLinkAboutMortgage_Hoskins"^� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS h' Year
:__ FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09) .
S ResaibeC M DePaR^ieM of Lo�l Govemmeru Firence �
� MAY File Mark
INSTRUCTIONS: � p� �:
To 6e filed in person or by mail wifh the CounryAutlitw or Co�nry RecoNer of the county whele the p�operty is located. -
Fitirg Dates: 1) Real Property Must file during Ne }rea� for which Ne deducfion is soughG �Counry Aud"rtor
2J Mobde / Manufedured Homes not assessed as Real Properry: Must file dunng the M1veNe (12) rtanfh�
befwe Ma 37 of eacA year the deduction is saght. �^ry R��
See reverse si0e add' a�nshuctbns arM quelfipt�n� , GIBSON C
MPb�am (°""efL .`°s�rL°"s °" .. . /J _
Ta�dng D' " Key nunGer I I ton
���.�17- 3o3-oa�. oCb2-dOS
Asezsed raqie � PoO�Y as d Mortpa ge�Canl � O r��s un0ai0 az d Mongage�� InOebtednes
MarM 1. amnt Mamh 1. rte r 1 E2te o( a
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�i (10. W�Id� ES �115I �ICf Clf2d 5�13R Oi YIiPJBSii Ii 01M2d WIS�I SIXI180118 Oi)IBf �i1dI15POY5B.
m RmrE is Wternnl Nan Met
Name of rtnrt�a9ee or crntract seller ��.X .
Mdress of martgagea or mntreC ae0er (numhar end straet «i: s�te.
y othv owner or halder of mortgage
� (nummr aro street �r, sfeu. era
Oaes e�n[ own p(opuly in erry oNa
couHy ui In0"eru? r—�
—� �p10. .....
Dt�a��er �0... ... .
Cal-d �p• .. °Z�•��'1,��
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What Ta�drg Disnirl?
couNn auortoa
zo _ —�
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Is Ne app0�an1 the sde
legal a eWitaWe ame(?
❑ Yes ❑ No
with whrnn
Is the property in Question: MnueOy Asscssed
❑ Real RoPeKY ❑ �!�Y �
Has Na deducCOn Eeen
for artent yraR
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r• �i
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� _ � � 13 � �'�" I ��,,�. �,:,��
I I We cerrofy urWer the penalry of perjury that the above aM foregdng infwmation is We and correct arW Nat the applipnt is a resident of Indiaria aM
owner I mntrad buyer of Ne aiwementioned property on date applicalion is filed.
Date (monfi, deY. Yae�
a9."'°'.fe�°'�i'YP"��11 —
resiEent
Pe�son authoiaetl Ey
IM 57/ee4 a1y sbte, end ZIP aotle
� S-4'reef V
ol Attomay v by IC 61.142-0.7
person (num0erarM sbeet ary. sfate.
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oace (mmN. eer. rean