HomeMy WebLinkAboutMortgage_Hyneman� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION � oun T nship Year
�'+ / State Fortn 43709 (R5 / 4-03) � � �
� PtescnDeE Dy Department ot Local Govemment Finance `
INSTRUC710NS: � � � File Mark
To be filed in person or by mail with the County Auditor ol the county where the property is locat�
Filing Dates: 1) Real Property: During the 12 months be/ore May 1 f ot the year the,deduction i�s�(R���tjv&�DITOR
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March��9the year the deduction is to 6e eNective.
See reverse side for additional instn�ctions and quali�wtions.
or contract
u
Taxing D trid
����
on reverse
Key number / legal descripti8n
,
b/,:�- 00.57, 0-. �- ,
number
0
: number ' '� �
7�0 � ��
Assessed value of real property a�of MoRgage / Contract indebtedness unpaid as of is ihe applicant the sole legal or equitable
March 1, wrrenl year March 1, current year .. ownef? �'es ❑ No
�J`�Ooo`� ' ., :
Ii no, what is his / her exaci share of interest? If owned with someone olher than spouse, indicate with whom.
If name on rewrd is diHerent than that of applicant, indicate below: Is the property in Question:
or
Address of mortgagee or contracl seller (number and street, city, state, ZIP
Name of assignee or
Address
owner or holder of mortgage
(num6erand sLeet, city, state, ZIP
Does applicant own property in any other I If yes, what county? What Taxing District?
county in Indiana?
Deduclion approved in the amount of:
�.ff/�m�).�[c�7
�
Signature
COUNTY AUDITOR
� 20 20
P
_ County Auditor
0
O Mobile Hmie pC &1.
Has this deduction been requested on
property for current yeaf?� Yes❑ No
20
20
certify under the penalty of perjury that the above and foregoing information is We and correct and lhat ihe applicants was / were
eni oi indiana and owner of the aforementioned property on March 1, 20
ire (owners_fu�l n�) �f Person authorized by duly executed Power of Attomey
, � � or b IC 6-1.1-12-.07
� A i�n Vn L.n--^ - - Y
of
of aulhorized person