HomeMy WebLinkAboutMortgage_Hurt.•�•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
r,. .; . FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fam 43709 (R812117)
�°�; f Prescribed by Depa�ment of Local Govemment Finance
INSTRUCTIONS:
To 6e filed in person or by mail wRh the CountyAuditor o/ fhe county where the propeAy is I�. ��
Fdrng Dates: 7) Real Properly: During the 72 monfhs be(ore June 77 o/fhe year the deducfion is to be eRective.
2J Mobile Homes assessed under IC 6-7.1-7: Behvean January 15 end March 2 0/ fhe YearLtAertl�cti� is to be eflective.
See 2verse side /a additional insW ' a�M qualifirafions. t� C �� L �l iS
Applirant (owner w mnhad r e re � on reverse si j �
/la� ,G�
i Key number ega ptbn SON C TY AU . eocitl number Page mimber
� a -1 - l-dc�o_���F o�"�' i�
Pssessed value of 2al popelty as d March 1, aarent year Akxigage / C�Uad indebledness unpaid as of March 7, Is Ihe app8cant Ihe sde legal a equitahle wmelt
auren� ye�Y C ,.-�7�
� J�VV ❑Yes ❑No
"^n, what is his I her ezact share of interastl If o.med with wmeone dher Ihan spouse, indicate wifh whom.
I Ir name on recwtl is d'rf(Mant than thal of applicant, intliple belo.v: Is Ihe property in quesUOn:
❑ Real Pmperty ❑ Mobile Home (IC G7.1-7)
Name of mortgagce or conVacl seller /� /'� ,.
\J WU
Atldress M moAgagee w oonUatt seller (number and sfreet, tity. sfefe, arM ZIP code) -
Name of assigrree w ofher owner p hdder of mortgage /
�
DCaNCC �iO..�...-:s.. �..
Address of azsgnee (nwnbe/ arM s4ee1, city, sfate. and 21P totlt
Does appicanf own property in eny other If yes, vrt C a r d\T �. ........ ..• ••• s this dedudion baen requested on pmparty
counry ui Indana7 �rtent yeaR
❑Yes ❑ No ❑Yes ❑ No
� COUNTY AUDITOR
Deductwn apprwed in the amounl of:
� 20 20 _ 20 _ 2b _ 20 _ 20 _ 20 _
Sig of n Audibr Counry Date (monN. d y A
��a-O
I/ We certify u der lhe pen ry of perjury !h the above and foregoing information is trve and correct and that tlie applicants was ! were a resident of
Indiana and owner of Uie a rementioned property on March 1, 2b
Signawre (owne/s IUI name)< Date (monfh, Eay, yee�
.1.8, �i
resitleM a ress of icant (number end street. city, state. antl ZIP mde)
�l�.s s. w�-� ���H �,rcr-mN r,� +��b�o
Person aulhorized by duly exewted PvMer of A[tanay w by IC 6.1-12-.07 Dafe (marfh, day, yen�
Address of aulhwized person (number and streeC crty. sfate. and ZfP mAe)