HomeMy WebLinkAboutMortgage_Hall (2)°'�* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun'
__ _= FOR DEDUCTION FROM ASSESSED VALUATION
• Sta[e Fartn 43709 (R71 / 6-09)
�' ,�,� � Prrwibetl q' DeO��rd ot Local GovemrtmM Firexe
�VS7RUCT10NS:
To be filed in person a by mail with the CountyAUditor or Counry Recorder o/ the county where fhe propeRy rs located.
Filing Dates: i) Real Properry: Must file dunng fhe yrear lor which Ne deduction is sought.
2J Mo6de / Manufactured Homes irot assessed as Real Properly: Must file dunng the twelve (12) monNs
6efom March 37 oteach year the deduttion is sought.
See reverse side for additional insLuctions and qual�cations.
nppl'xaCtja� yrcontrart6uyer-seeresvicnortsmrevers�eside) IB�
Tadrg DisbnY
Ii M� W�12I 6 �ILS / �IEf EI3f15�18f8 OI YIfPl2517 �
tl name m recdd 5 drRUent Ihan ihat of app6wnt, uMipte Debw.
Name of mort8a9ee or mnVSCt
Fwm f�ed wiN:
T � �fdi�ty�a���
nuoiroR
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- / o -ooy� 8i�-o al �
x inCebtedness unpaiA as of MMgage I Convaq mCebteCn¢s �mpaid as d Is Me ap i Ihe sde
ar date o( appi'vtion legal «epuitade owreY.�
1 O � ❑ Yes ❑ No
If o'wnetl wiCi someone dher Man spouse. iMite[e wBh wMm
Is Ihe P�o7�Y in 9uesUOn: MmiaDy Assessed
� RC21 PRlpelty ❑ Afif1U311yPS5CS5C�
r.wak r�ome nc 6ti-,
rtKx�agee w mntratl se�er (nunbe/enit�hee; cdy, sfate. arN ZIP codej
w omer owner or ndaer ot morigage
anaress ot azvgnce (nurwer am suee4 my. seie. am ur cme�
Dces apptirant awn property in any other I( yes. wh2
Countyinlnd"ena? r� .. I"I ..
�he amoum oE
20 � 20
I/ We certHy under ihe penal
ownerlcontractbuyerofthe
4Ma� Ta�drg Di
COUNTY AUDITOR
-� .
1����"a m �
i►-s�a�
20 I 20 I 20 I 20 I 20
I Counry I Date (march. daY• Y��
/1�liLw
Nat e and (oregoing infortnalion is We and cortect arW Nat Me applinn[ is a resiCeM W IMiana aM
ned r perry on date appiiration is filed.
state, and
Pe1wn autM�aetl Ey EWy ezew�ed Power of mm�eY or by IC 61.1-12-0.7 I Dale (monN. daY. YEa�)
ACdress of auNOrrzed persm (number aM sbeeC tity. state. enE ZIP wde) .