HomeMy WebLinkAboutMortgage_Hasenour (5).��•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
.: .-
� FOR DEDUCTION FROM ASSESSED VALUATION
- Slate Fartn 43709 (R8 / 2-07)
�� .a�. ' Presrnbed by DePartmmt of Local Govemmenl Finance
Fi a
INSTRUCTIONS:
To be filed in person w by mad wifh the CountyAuditor o7 the county where fhe properfy is located. ,(!��
Fd'a,g Dafes: 1) Real PropeAy. During the 12 months be%re June 77 of the year the deduc6on is to be eRec6ve. be �t/�t ''`'V�
2J Mobile Homes assessed unde IC G7.7-7: Behveen January 75 and March 2 0( �e year the deductiol'�iStoON (;OUN� AUDITOR
See reverse side lor additional insWCtions arM qualifirations. li t35
reverse side)
'�° Kea � ,�3 0°.� a oo -Dod .,3YY-o � �
rdu¢ pf real popaty as d March 1. airenl yzdr MMgage / ConUad c�debledness unpaid as of March 1. Is Ihe a
curtenl Year a 5, QQ Q
e:act
If �ame m record is dittereM Uian Ihat of applipnt indinle below:
Name of rtartgagee or caniract seller � �
nddress or n,onqagee or oonUaa sel�a (iwmber and SreeC dry, swte, ar�d z�P code)
Namc af asvgriee w alha oxner w hdder of moriga9e
(rnmber arM sLeet. city, s(ale. and
Does applicaM vxn poperty in arry dher
county in Indiara?
❑Yes ❑ No
'S'1
apprwed in Ihe amount of:
4C �f��-�
spouse. �cate vrith whom.
��
❑Yes ❑ No
Is �he propeM in question:
❑ Real ProceM ❑ Mobile Home QC G7.
UI'115'G' \iQ..`�^�^-� . . .
C.11'C� 1�'�. ....�!,`-`' —
4Vhat iaz �} • . • . . . . . . . P��Y
`B���Q,� 7No
COUNTYAUDROR
20 I 20
Counry
�
20 _
I/ We cerofy under the penalty oi pe�ury that the above and foregoing infortnabon is true and corred and that fhe appGcants was ! were a residen� of
Indiana and ovmer oi tlie aforemen6oned property on March 1, 2p _ _
�•_sidenl adtlress o �rrt (number and sGeet al . slate. and ZIP mtle)
�,Z95 �-. � s� � 8 ��a, b s�c,/� //V �7G 3
Pason authwaed bY duN ��t� Power of FLL or by IC 61 1-72-.07
Address af aullor¢ed pe�son (numbei arM s4ee; cdy. slate, arM LP �tle)
Dale (monlh. daY.Y��)
Date (monN, day, yearj