HomeMy WebLinkAboutMortgage_HensleySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un . T hi Year
FOR DEDUCTION FROM ASSESSED VALUATION :' J
S1�e Fartn 43709 (R70 /it-08)
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INSiRUCnONS Fle MaAc
To 6e fded in persan or 6y mad witli Ure CountyAuddorW fhe county whera the poperty is bcated.
Rliig Dafes: i) Ree/ PropeAy: Must h7e dunng fhe year for which the deducfion is soughf.
T) Mobi7e / Manu/ectured Homes not essesse0 es Real PropeRy: Musf hle dunig Ne tweNe (7T��7ths bet� eich�ol each yea�
thetleduclionissaight ��F� C%OUN7Y AUDITOR
See reverse side far adddional insWCtions aM qualfications
AcoGwnt (ownerar mrdrad drya� - seo �esj5�ions m revo.m sde) � �
aurig Distrid ✓
wssa-�a ��� a� n�y � a
Mam.h 1, amenl Y� .
N rq. what's ha / her a`ad shara of i
Y name on rewrtl is ddfwam lhan tha
�i2lf18 � f11ClI9dlJ88 Of IbI1b8C� SB�Bf
. ii- aoo -� 3� 8� �s '
Matgaga I Cantrad indehletlnass unpaid as d
Mamh 1, amerE year
AdCrass d mot�gagee u wrtrad seAer (ntrn6erand sheot oh'. smte. ana Z� code)
Nama d assignee or ofher amer v MEer of mdtgapa
nea�s a assq�ae pw,ro« aw s�et ary: uam, a�v
Does a77��t am prope(ty in am� alher
�y �� imm��
❑ Yes ❑ No
�1 A /.� / /I- "�-/
U yes, wha� muNy?
tt cwned wdh saneone alher ihan spou:s.
COUNTY AUDITC
a9 of is lhe aVP�b Ne mla
Iegal or eQUdable awieft
O Yes ❑ No
P�M'v� quesiion: MnuaM Assessed
P.�PfO(18lh' ❑F1flfiWq'Accacwrl
iviObllC fiC(IIE (�C (ii.
�-��USCE y �t'Oy f�-
�(;�y L
�-�/� 8
gM
20 _ 20 ZO 20 _ 20 _ 20 _ 20 _
�nalure d Caunb Audaa Cau�riy Date (rtroNh, daY, Y�)
I/ We certify under the penalty of perjury thal ihe abova and faregdrig'v�formation is We and red and that Ihe appficant is a residenl o� Indiana and
owner / mntrad Duyer of Me afo entioned property on date ' n is filed. �
�nature sfiID�me) pate( daY n
,�._ 2. i o..� Oo,A_ �,V%„�.. .� o„A D,,2 7"�';, ll; 9
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