HomeMy WebLinkAboutMortgage_Hillry� STATEMENT OF MORTGAGE OR CON C I DE�D E�. Coun Township Year
__ = FOR DEDUCTION FROM ASSESSED V�U�TI 1 1L/
� State Fortn 43709 (R71 / 609)
♦ 1 Presaibed rd of Laa1 Goremmeru Fnance
"" "'°�"fe DEC 1 4 2011
�STRUCTIONS: �r�
To be filed in person or by mail wifh Ihe CountyAuditor or Counry Recwder o/ tpeW(�n ! properfy is bcated.
Filirg Dates: 7) Real Property: Must file durirg the yea� for which the deduction is sought.
2) Mobde / Manufactured Homes rrot assessed as Real Properly Mu �(1�p{cpQR (12J months
before MarCh 37 0( each year Ihe deduction is snughG G I BSON
See reverse side for �dC�fional instnxtions and qualificyf'aqs.
�y
Asesed relue d real pmpertY as of
A/22h 1, tlmMtl year
It m. what's his / her emct share ol
If �rtiC
Name
xener
of rmrtpa9ce a mntrm se0n
� � �t(�-li-ito-�-a
Moripage / ContrxG'udebtetlness unpaid as
Mat� 7, wrteqUyesr � � Q
I I
uWicate 6elow.
*4 uN state. aM
Name a( asvgnee n o1N''
� ao�. �
A�"� tiO�, {'� �)
/ "C` � .
��� •�.,.`• � � tcounty�
� `O ��v
Ca` �� a� j ''"''
_,u of
�q\ �
20 _ � 20 � 20
I I We certify uMer the penalty of peryury �at ihe above arW (c
owner / mntract buver of the atorementioned pmperty on date
dty, state, aM
authoraed Oy duty executed
person (numberarMSbeetmY.sbte.aMZIPCUde)
File Mark
Form (Jed w�h:
��CounryAuditor
❑ Counry Recorder
a� RecoN numDri Page numEer
oa'
itrarl mtlebtedness unpa Ne eppfifant Ne sde
tion legal a eQuRade awneR
❑ Yes ❑ No
If owireE wiN someare otlwl Man spouse. iMiqte wfth wlwrn
Is Cre 7�PertY in 9uestion: MnuaOy As.^.esse0
❑ Reai afoPenr ❑ !!^��!aM �
Wha� Tati�g D'slrirl? I Has NIS 4eUUtYwn Oe
for wrrent yeaR
4UDROR
2� 20
Caunrv • _ Daie (mont
2puestetl m propeny
❑ Yes ❑ No
F,,:
infortnaUon is we antl correc[ arid that Ne applicant is a resident of Iridiana aM
ion is filed.
Date (monN, day, yean
`�'7� 'IIl