HomeMy WebLinkAboutMortgage_Hess (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fortn 43709 (R71 / 6-09)
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INSTRUCTIONS:
b 6e filed in person w by mail with fhe CountyAuditof or Counry Recorder o/ the counry where the property is Ioca�N
Fflirg Dates: i) Real Property: Mus! file duri�g fhe }rear for whicA the deduction is sought.
2) Mo6�7e / ManWactured Ffomes rrot assessed as Real PropeAy: Musl file during tAe hveNe (12) monfhs
6etae Alarch 31 0/ each yeer the deduUion is mught �yn
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See reverse side /w addifionel inshuctlons and ovalificatrons.
Icey raimnu � kpai ees�
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what 61ds I ha exaG sAare of inWrst9
If rwne m remrC's 6Remn[ Nan Nat W appOCanL tr�dkam Gebw.
Name W rtartg�a m mntrarl aeBer r_ I^
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Mdtas d rtqrk,7agce n oontratl sr�er (nun6ei erd sneel amte, erN LP code)
Name o1 assignea w dhu ownu or hdder of matgaga
Pdtl�ess ot assignea (num6ar and sbae; tlt}; state, aM ZIP cotle)
Dces eppli�nl am propeM1y in ary oNtt I I( yes. �Mat
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az at ��BMjePI�Cm� 'vitlebtednrss un7aid as
Counry Auditor
Counry Remrder
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Is Ne eppOcant Me sde
kgal u epWtade oxneR
❑ Yes ❑ No
I( owne0 wiC� someone otlar Ihan spouse. udirate WN whan
Is the property in purstion: MmiaOy Asmssed
❑ Re� amveM ❑ rv,^ua�hw�
Has Na daduction baen requested m p�operry
t���� ❑ Yes ❑ No
20_ � p_ � p_ � p
\ I CaunN , Qy '_ JN � I Oate (month. d�y, Yea�' �'�
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yoing infortnalion is We and cortect arM that the applinn[ is a resident of IrWiana aM
.�e appiication is filed.
Date (mmth, eaY. Yaa�)
`E' � - it. H�.� ds,
Pasmautf�• .wero/Atlart�eYa IC61.1-12-0.7
.,,an (numCer a�M sbeet �+N. sm�.
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