HomeMy WebLinkAboutMortgage_Hasselbrink (3)�� � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
I\- = FOR DEDUCTION FROM ASSESSED VALUATION - Township _ Year
\: �� S�ate Fortn 43709 (R6/ SO6) �
Resrnbed 6y Department at �ocal Govemmenf Finance
MAY 0 1 2007
INSTRUCTIONS: File Maric
To be filed in person or by mail wdh the County Auditor of the county where the p�operty is located. `�j� �
Filing Dates: 1 J Real Property: Dunng the 12 months 6efore June 11 of the year the deduction is to be efle+E6Set
2J Mobile Homes assessed under IC 6-1.7-7: Between January 15 and March 2 0l the g7@gtb� � � Ib�sffective.
See reverse side for additional insfruc6ons and qualifications.
or cont ct 6uyer- see restri ions on reverse sit
e
Key number / legal
a6 �-ns-la�
Auessed vatue of real property as of
March 1, curtent year
If no,
If name on
exact
of mortgagee or contract
current year
Address oi mortgagee or contract seller (number and street, city,
Name oT assignee or other owner or holder of mortgage
Address oi assignee (number and streef,
Does appliqn[ own property in any
counry in Indiana?
20
\1
state,
Ii yes, what counry?
►��-.�,�.�,- ��io.��o7...3.s.a. �
approve� CIll'(� �'0 . .....................
20 Q� I 20 �
�
LV
Counry Auditor
3?3-0� sl
:dness unpaid as of
��,i��
Q� /
Is the applicant the sole legal or equitable
ownef? ❑ Yes � No-
If owned with someone other than spouse, indicate with whom.
s me pr
❑ Real
ZIP
❑ Mob�le Fbme
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a� Q �
, �� a.vrrr -3,2�
WhatTaxi � 352(.
AUDITOR
20
20
20
6�1.
on
No
We certify under the penalty of perjury that the above and foregoing infortnation is true and cortect and that the applicants was ! were
�sident of Indiana and owner of the aforementioned property on Marrh 1, 20
lull name)
address of
�S'd �
Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07
Address of authorized person