HomeMy WebLinkAboutMortgage_Hayes (4).+°•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
,�,... _; FOR DEDUCTION FROM ASSESSED VALUATION
� � Slale Fartn 43709 (R81 2-07) � � �
::;y,. � Presmbed by �epartment of Local Govemment Finance
INSTRUCTIONS: QUGF�i ���$
To be filed in person orby mail wdh the CountyAuditor o/the county where Ure property is bcated.
Fding Dates: 1 J Real PropeAy: Dunng the 12 months before June 71 0( the yearthe deduction is to 6e eRective. d
Remrd num6er Page number
� �o2D/-d6�•,3/%-G6
Mortgage I Contract iMebtadness unpaid as of hlarch 1, Is Iha applicanl Ihe sde legal or equi�ade ovmeR
airtent year �
❑Yes ❑No
f wmed wi�h someane other than spouse. inGcate wilh whom.
n rame m record is differenl than Ihal of appiicanl indimte belar.
Name af rtwrtgagee or caniract seller `
nddress or mortqagee « conbaa sel (nurt,ner ana srreel. dry. srat�
Name ot assgnee u dher owrrer or hdder of morigage
Address of assignee (number aM stiee; cAy, 5ate, arM ZIP code)
Dces applicant own property in any dher If yes, whai counry7 I Whai Taxing �isiricl?
counry in Indiana?
❑Yes ❑No
Is Ne praperty in question:
❑ Real Propertv ❑ Mobile Home (IC G7.
Hes
(a t
uesled on property
❑ Yes ❑ No
COUNTY AUDITOR
Deduction apptwed in �he amaunt of:
20 20 20 20 20 20 20 _
Synature of CounryAUtlaor Cwnty Dafe (rrronlh, day, yeaQ
I/ We certify under Ihe penalry of perjury tliat Ihe above and foregoing information is We and coReG and tliat tlie applicanfs was / were a resident of
Indiana and owner of the aforementioned property on March 7, 20
�na �r (owners INI neme) Da�e (rtronlh, OaY Y�h
i
�tlent address of icant (n r antl slreet cRy. state. an0 LP code)
� IO - S Si, a �' D
Perwn authors by duy exeated Poxer of Attomey or by IC 61.1-12-.07 �ate (manN, day. yea�
Pddress of aulhor¢ed pasn� (nurtrber and streel cdy, sWfe, aM Z!P cude)