HomeMy WebLinkAboutMortgage_Hilton"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION ��
� � State Form 43709 (R71 / 6-09) �
� wr P'esaiEetl y' OePartr�ct¢ a! Lxal GovemmeM Finsnta
� � 4File �
wsraucnoNS: a
b be filed in person a by maii wrfh the CounryAUditor or Counry Recorder o( the counry where the property is ed. -
FiRrg Dates: i) Real Property: Must h7e dumg the year fru whirh the deduclion is soughL � Counttt'yyyl Audimr
2) Mo6de / Manufaciu�ed Hanes not assessed as Real PmpeAy: Must ble dunng the tweHe (72J rtanths [� �nty Recorder
befire MarU 31 0( each year the deducOOn a sough[. �. T
See reverse side /or additional insLuctions and qual'dications. n
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Key rn�meer
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nss�a�ma� o�r as or n�n¢�9e i ca,vaa o-
Me�h 7. arma year MafU 7. w�renl y�r
aa� �
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tl rwrre m remtl is diftemnt Man ihat ot app6�nt, tr�duate Debw
mntrap spAer n �
of rtiortgaqee
smm.
t+ame a�� a a� w.,,�r a nm�r m�e
Pdtlress of azsgme (num6er and street �Y• smte. ard LP coEe)
Dces eppli<am ovm p�nperty in any oMer If yes, whx
munry in Ind'au? ❑ Yes
❑ No
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G id$dattTnM7�6�'r' � � Page numDer
o -oa / io ao � �
lortgage / Contraa mAebtedness �m7� av d Is Ihe aPPfi�ni tha sde
ate of aGP�� � a WNmde rnvrrll
❑ Yes ❑ No
ith someore other ihan sPa�. ind'�te with wlwm
Is the P�GenY in Vuestim: MwaDY Assesud
❑ Real ProPert�' ❑ Mnua1lYA�ssed
AlobOe F1mie (IC 61.1-i
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DCM1Y
20 20 _ 20 _ 20 20 _ ZO 20 _
Signanue N CamtY AuCimr Counry Date (rtarvh. daY. Y�/1
1/ We certify uMer Ne penalry ot perjury that the above aM foregoing infortnation is true and correct arid Nat ihe appGCant is a resident of I�iana aM
owner / contract buyer of the aforementioned property on date appliration is fileC.
�up resEent atldFcss of appfwnl (numbe� antl stree4 mY, s�te. and ZIP c�tle)
X 58y3 sov� r( �oso wEST o�.v�,.ls�
Pasm auth«rzM Dy dWy eseartetl Po� o(AVm�eY or M IC 61. t-12-0.7
Pdtl�s of authome0 Oerson (numOer aM stee4 �QY. sfale, an0 ZIP mde)
Date (rtmf�. d�:
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