HomeMy WebLinkAboutMortgage_Haynes"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm 43709 (R71 / 609)
1 � Presaibetl by �epartment af Laral Govemmenl Ftarce
INSTRUCTIONS: �
To 6e lded in person or by mail wifh fhe CountyAUditor or Counry Rewrder o! the county whe2 the pioperty i� Iq�t�. A
F7irg Dates: i) Real Property: Must fi7e dunng the year for which the deductbn it soughL H IY Y
2) MobAe / Manulactured Homes rat assessed as Real Pruperty Must fiIe dunng the fweNe (72) months
6etore March 37 0l each yeer Ne deduclion is sought C.�J, M,.�-Y,
See reverse side for adUitional instrucGons and qualrfications. (
AoofirantMlr�er � mntract truvb - see ms0ic'L'ons m re�erse sidel�. N C(11 IAIT
�raNe d re� P�D�Y as of
1. wmY year
Iq, W�1816 hl5l hCf 8F2U Sh3IB O
�} �M12IX1 R'mfd
m m«tqa9ee «mnwaa
Name at assignee or ahe� owner w hddu
AEdr�s of asig� (�umbe,e�W sUeet �l: staffi,
munry
� Counry Auditor
❑ County Recordu
Rem�tl numbrl � Page number
ContrarllMebtetl�ress unPaid as o( I Mort9a9e / Contre,Y uWebtedness �mG� as
rtemye� / � tlate ot appGptan
(l /l
any oNU I I( yes, wh2t coun
Yes ❑ No
dipn app�oved'o� �he amouM oF.
20 _ 20 _
o( Co�mb P.uditcr
r�
CIC (#OpPltY 111 QtIRLO
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Di•a���er NO..�Q... .
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ca�-a �o. ...��5� ........
� 88�'1co �'
20 _ � 20 � [u
�iiade owrel.+
Yes ❑ No
l�
�
me (IC 61.
an reGUested on G�Y
20
I/ We certify undes Ne penalry of perjury that ihe above ard toregoing infwmalion is W e and cortecl antl that Me applirant is a resident of Indiana and
owner / mntracl buyer of fhe atoremenibned property an date appliration is filed.
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