HomeMy WebLinkAboutMortgage_Hughesrt�"° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
° = FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
S- � State Fortn 43709 (R4 / 10-Ot) �� .
�� PrescnbeA by DepaNnenl a1 Local Govemment Finance
INSTRUCTIONS: � � � .Fil ark
To be (led in person or by mail with the County Auditor o/ fhe county wheie the property is loc d.
Filing Dates: 1) Real Property: During the 12 months befo2 May 11 of the year the deduction �s o be eFfe � e.
2) Mo6ile Homes assessed under IC 6-1.1-7: Befween January 15 and March 31 of the ��kth� c�dt{� is to be eHective.
See reVerse Side lor additinnal instnrctinn.c and nualificalinnc `� �
Applicant(ownerorco ractbu7�r-se 2strictionson vere ide) "' cio�n.�r�•• r�; .,�,,;��R
Taxing Distrid Key number / legal de iption Record number ��
P��LiP'� � D � _O � O (�� �D Page number ('� D �
�i�c�ii.,�r• �i or
Assessed value of real properiy as of Mortgage / Contred indebledness unpaid as of Is the applicant the sole legal or equitable
March 1, wrrent year March 7, current year ownef? ❑ Yes ❑ No
If no, what is his / her exad share of interest? If owned wifh someone other lhan spouse, indicate wilh whom.
If name on record is different than lhat ot appiicant, indicate below: Is the property in question:
❑ Real Properiy ❑ Mobile Hane QC G1.1-�
�ame of moRgagee or contrad seller �
Address of mortgagee or contract seller (number and st2et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, state, ZIP code)
Does applipnt own property in any other If yes, what county? What Taxing Distrid? Has lhis deduclion been requesled on
county in Indiana? property for current yeaR � Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
zo zo �/� 20� zo 0�_ zo O zo � zo �
a � � P �' P
Signature County Audifor Date
I/ We certify under the penalty of perjury that the above and foregoing information is true and corced and that the applicants was / were
resid t of Indiana and owner of the aforementioned property on March 1, 20
' ur (qwners fl ar��7e) Q Person authorized by duly executed Power of Attomey
.,I ` or by IC 6-1.1-12-.07
V
Fu sident ddress of icant Address of aulhorized person
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