HomeMy WebLinkAboutMortgage_Hackler'°n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
___ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R11 / 6-09)
�' � Preuribed 6y Department of local Govemrtrent Friance
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NSTRUCTIONS:
To be fifed in person w 6y mail wifh the Counry Auditor or Counry RecoNer of fhe counry where the property is located. D
Fding Dates: i) Real Property: Must file during the yrear for which Ne tleduction is wught.
2J MobAe / Manufactured Homes rat assessed as Real Property Mus[ file dunrg the M1velve (12J months
6etom Ma�ch 31 of each year fhe deduction is saqht. C
See reverse side for addifional instruuions arM qualifrcations.
AppG nt (owner oroonearl buye see resMUions rerse sitle)
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Ta ' Disbia Key num0er / legal desaiplion RecorE number Page numbrr /
a-�� �� - a-is- ao -odo, aaa - oa, � �y
Aaessed vaWe oI2a1 p�operty as of Mwtgage / Contraq iMebtedness unpaid as o( Mortgage / Contract inCebtedness unpaiE as of Is Ihe appl'vartt Me sole
Mardi 1, cunent ycn Memh 7, curtent year Ga[e af appikation legal or eQuitable owrieR
77 DDD ❑Yw ❑ No
If no, what is his / her exacl share of interesi? If ovmetl wiN someone other than spouse, i�Wicale wlih vAwm
If nane on record 5 AiRerent IAan Ihat o( aDP�nt, iMicate below. Is Ne Pmperty in Quation: MnualN AssesuV
❑ Rea� aroperty ❑ nnnua�y r�sessea
Name of rtrongagce or �tract seller
Mdtess of mdtyagee or wntract seller (numbel and slmetQfiry, sfafe, arM Z/P code)
Name ot assignee w other owner or hdder of mortgage
PAdress of assgnee (number aM stree; tlry, state, antl Z/P cade)
"i 4J �1 F ��✓' - 7, - a O D b fl
Ooes applimnt own property In any olher I( yes, what counry? NRat Taz
muMy in Ind'gna?
❑ Yes ❑ No
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COUNTYAUDROR
�umon apyoved'u� tlm amounc of:
20 20 20 20 20 20 2(1
Sigrenue of CamryAWttor Counry Oate (month. daY. lea�
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I I We certify urber Ne penalty of perj Nat Ihe abov nE foregoing infortnalim is we and cortea arW Ihat Ne applinnt is a resident of Indiara and
amer I mntrad buyer of the aforemeMioned prope on date applica0on is filed.
Sigfaeire e/s hdl �ame) Date (rtmfh. daY. leah
�II �� �� �applicani (numberand SLee( aty. sfate. anE ZIP oode) ���
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Persan autlror¢eC by G�dy exeaitetl Power of Atlomey or Cy I 61.1-12-0.7 Date (rtanN. Gay, yea�
Pddress of authoraed person (num0e� antl streef, dry, stafa, antl Z/P oode)
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