HomeMy WebLinkAboutMortgage_Hayhurst\.�°•��. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�e_.. ,'; FOR DEDUCTION FROM ASSESSED VALUATION
SIa1e fam 43709 (RS I 2O7)
�' � Resa3ed by Deparb��rt of Local Govemment Finance
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INSTRUCTIONS: Fi19I maAc�
To 6e filed in person or by mail wrfh the County Audifo� 07 fhe county where the property is located.
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Fd'aig Dates: 7J ReaiPropeAy: During the 72 months belwe June 77 olthe yearthe deduc6on is to be e(iective.
2J Mob�7e Homes assessed unde` IC 64.1-7: Behmeen January 75 and Maich 2 o/the year fhe deduction �'s t 8 tjve.
See reverse side fcr additional instrucbons and qualilrcations. H ��(��i6
Applicant(ownerorcon d6uyer-seeresViclions rev sde)
T Di ' Key nu / Iegai esoiption
o`Z (o-I-►
Pssesserl value real propety Mardi 1. nment year Mortgage /(
wrtenl year
�r�what is his I her eaacl share of inlerest?
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It name on recnrtl is diBerent Ihan Nal of applifant, indifate below:
Name of mwtgagee orconVacl seller
mortgagee or
owner or hdder of mortgage
stafe. arM ZIP
Address of assignee (n,anber aM sheet. crty, sfale, end ZIP oode)
Does applicant own property in any Wher
caunry in Inda�7
❑Yes ❑ No
�eduction approved in lhe amount of:
�� �_
Indiana and
�0 �p0 . lo-Od-I �
dness unpaid as af March 1, Is �he app6nnt Ihe sole legal or equilade ameR
)(� Yes ❑ No
If owned wiih sameana olher lhan spouse, irWipte wiU whom.
couNrr
20 20
�e properly in questian:
Real PropeAy ❑ Mobile Home
NM1 � U RsT J Am�r+y L
-- I 13�0 ��
� O � O /
5
20
20 _ � 20
�,ounry � �e�e �rrwnu �.i � I � V
�
e penairy of rjury tliat Ne above and foregoing intwrnation is We and cortect and that the applicanls was / were a resident of
Me afaem tioned property m Marclyl, 20 _�.
e) . / Da+e (monm, ear. yea�
a�M ZIP code)
(
Pason authoraed
w
Address ot authaizetl persm (numbei arM s6eef, ci(y, state. aM LP code)
Dale (monfh. day. yea�