HomeMy WebLinkAboutMortgage_Haley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS P I U ?R l Year
r�'sr= FOR DEDUCTION FROM ASSESSED VALUATION
:(4,1:•_.1-!' State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Finance '^,9
AUG • FueivArk
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.- - ad xlth
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. �unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months OR
before March 31 of each year the deduction is sought. GIBSON COON Ueoomy Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buy -wee restrr�t�orss on reverse side)
T xirg District �}/7 Key}�4nrtnd/ber/legal 'pion Record number Page number
Iv A& - 19-31-/o/- 000, /07 -oo7 / d. a96. 69
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1.amen year March 1,anent year date of application legal or equitable owner?
,s� Q00 0 Yes 0 N
If no.what is his/her exact share of interest? if owned with someone other than spouse.indicate with whom
If name an record is different than that of app&ant,bdicate below Is the property in question:Annually Assessed
'Si-keel Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5 /3
Address of mortgagee or contract seller(number and street,cay state,and ZIP code) •
Name of assignee or other owner or holder of mortgage
r___________1 '
Address of. nee(number= I. street,city,state,and ZIP rode) / fir 1
I ✓If. ∎ L- iia r u 11'-f
- •.-app Irani property in any other If yes,what county? What Taxi,
county in Indiana? ❑ Yes ❑ No
No
is —a 9c
COUNTY AUDITOf
Deduction approved in the amount of:
20 20 20 20 i —
I
Signature of Couunty Auditor County Date(month,day,year)
I I We certify under the penalty perjury that hove and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner l contract buyer of the aforementioned rty on date application is filed.
kSig time(a I' hill nae) . (� Data(month,day,year)
a tress o pe&can_(�umbar a�rd /irate,and ZIP e)� - 7 G 3
Y0 7 I� A-1 /( f -d rib Y 9
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(T,,c.rth,day,year)
Address of authorized person (number and steel,city,state,and ZIP code) .