HomeMy WebLinkAboutMortgage_Hensley (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ : FOR DEDUCTION FROM ASSESSED VALUATIG�N
• Sfate Fwm 43709 (R17 / 6-09)
ti Presaitea q oepertmern w Lod covemment Fnance
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INSTRUCTIONS:
To 6e filed in person or by mail with the CountyAuditw or Counry Recorder of the county where the p�operty is located.
Fitirg Dates: 7) Real Property: Mus! file dunng the year for which the deducLOn is soughl. ,�County Auditor
2) Mobde / Manu/actured Homes rrot assessed as Real Pmperly: Musf file dunng the IweNe (72J months
before Maich 37 of each year the deductrion is sought �-� Go�rt,;p%ecorder
Sge.acvear�sideforadtlitiona/insWCUonsandqualifitatbns. ' � � � IBSONCOUNTYAUDiTOR
�pfi�n ( m C b - see rOstrirbcrys m ide}„ i. _ _ . .
M2mh 1. ar�vit yqr - I MeiU y��epl
T'�/_L
/
I( rw. what k his I her e�mtl share Of Nterest?
If narne m recad'o dtlfemrt Nan iha� of app8mn; uNV�ate beb�r.
Nama of rtartgagee ar mnUact seller
ndaress ot mortqagee «cono-aa seo
;_d�2p0/.JS/-O�']
iMe6tedness unpaid as of Mortgage / ConYa�
cdy. stam.�M LP cade)
Nart�e af assignee w othrl awner w twlder of mp�tgage
P.dEfass of 855e,y�ce (number antl stree; tby, 57ate. anG ZIP cc
Oces epplimnt ovm property in a�ry oNU Ii yes.
counry in IMiana? ❑ Y�
❑ No
Deduclion appmveE in tlre amount ot
20 _ 20 _
s�, .�m, ,�
I/ We certi uMer enalty of
�-IEz�s��-�4
bR.dness unpaid as d I Is Ne ep�t the sole
legal w eQUita6le amelt
❑ Yes ❑ No
spause. Indicale wtth wtnm
Is ihe {wperty in Quesron: Mnua�y Psusse0
❑ Real Roperry ❑ Armually Assessed _
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2q _
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h aboh
x oertv�
�ul revdent atldre3s app�mant (numGer antl rJty, state, a�
(2�h �So,� �,���r7o,✓,
Person authw¢ed Dy Ouy eseated Po«er of ey m by IC 67.142-0J
AdOress of a Wior¢ed person (number a�M street, city, slate. and LP mde)
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