HomeMy WebLinkAboutMortgage_Hasenour� �.�.
, i �'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
`i'�s FOR DEDUCTION FROM ASSESSED VALUATION T h' Year
'': ..�i+ S�ate Form 43709 (R6 / 5-06) . . � . . . . . . .
� Prescnbed by Oepartment of Lool Govemment Finance' , � �� �
OCT 1 5 2007
INSTRUCTIONS: ' � � File Mark
To be filed in person o� by mail with the CountyAuditor o( the county whe2 the propeRy is located. �p-�y�,�, �
Filing Dates: 1) Real Property: During fhe 12 months befo2 ,lune I7 0l the year the deduction is to be efle tE ive.� �
. 2J Mobile Homes assessed unde� IC 6-1.1 J: Betweeh January 15 and March 2 of fhe y6�9K�H6H11dEIdNil�UCb�6ective.
See reverse side for additional instruclions and qual�caGons.
Applicant (ow� or confract 6uyer -
_ . , ,
/
� / C
on reverse
Key number / legai description I Record
rage numne
�-/3- - oa- o. �a�- �b�
Assessed value of real property as of MoRgage / Contrad indebtedness unpaid as of Is the a�
March 1, wrrent year March 1, cunent year ownef?
If no, what is his / her exad share of interest?
c cne soie iegai or
❑ Yes ❑ No
If owned with someone other than spouse, indicate with whom.
If name on record is different ihan that of applicant, indicate below:
me of mortgagee or contrad seiier ��
Address of moitgagee or conVact seller (number an tieet, city, state, ZIP
Name'of assignee or other'owner or holder of mortgage
Address of assignee (number
Does applicanl own property in any
county in Indiana?
Deduction approved in the amount of:
state, ZIP code)
If yes, what countyl
f��H ������
P I P
Signature
s the praperty in quesGon:
❑ Real Properiy ❑ M�e Horrie OC 61.
�u�-Tru t NASEUou2
What Ta: ���.�( j� �� ;ted on
�s❑ No
U'1- C� �3 �
COUNTY AUDITOR
20
County Auditor
20
3�7
Date
20
We certify under the penalty of perjury that the above and foregoing infortnation is lrue and correct and that lhe applicants was / were
resident of Indiana and owner of the aforementioned property on March 1, 20
I
��� .: ...-, '!�� �j• � •
or by IC 6-1.1-12-.07
4ddress ofauthorized person