HomeMy WebLinkAboutMortgage_Hupp"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T h
__ . FOR DEDUCTION FROM ASSESSED VALUATION
�. '. .• State Fortn 437091R11 / 6-09)
yw r Presrnbetl by DePart�raM o(LMaI Government Firerce File �( G 1 2012
wsrnucnoNS: i
F«m maa �;m:
To be lled in person w by mail with the CounryAudim� or Counry Recorder o/ the counry where the pmperty is located. �, �.
Hflny Dates: 1) Real Pmperty: Must !le dun�g the year /or whicA the deduction is sought Counry imr
2) Mobde / ManuFactured Homes rrot assessed as Real Property: Must file during the hvelve (72) months f�'1 �ou°1v
6eforeMarch37ofeachyearfhedeductinnissought. IBSQNt,VUry DITO
See reverse side for adtlifionel instructions and qualfications.
AnaGfantfownerorcontracfbuYeL;seereaficbQ reve/sesvfa) „ ��/
tt
1,
m remfd is df,Ferenl Nan tt�at of appGrant, utlwate
pf mortgagee w trntraU seller
o� o_ 3. `a� oa-i ' o �a /�.s
�! Contraa indebtedrress unpaid as of Mortgaga I Contraa iMebiedness unpaid as d Is Ne appl'�nt sole
wrtenl yeer Eate o( aOP�� �egal w equrtaWe ame/?
❑ Yes ❑ No
if wmed with someorre ocher ihan spouse. iMkate wM Miiom
hclw` Is ProPenYinVUesOOn:MnuaDyAssessetl
Real RoPenY ❑ ��!�Y � . . .
ctiY. state. aM
tJame M assi9nee or other owner or hdAer W mortgage
MGress ot augnee (num6e� aM atree4 �Y. s�. arM Z/P cade)
Deductic
20
7l�i�A
�
/
propeny in any dhei
❑ Yes
Dra�r�er NO... �� � .....
Card NO. .......� �� .1.....
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Power of Atbmey or Cy
person (numberarN sbeet. dry, sp(e, anG ZIP codc)
COUNTY
�p
� �(._.
Taavg Datnd7
20
-3_/a
Has �h'a dedurbm Eeen
� r« a,rrem year.
20
J��c
ies�d an propvty
� Yes ❑ No
o� ���un, aay r��
20
7 informalion is We and cortecl aM thal Ne applirant is a resident of Indiara aM
3tion is filed.
Date (monfh, day, yea�
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