HomeMy WebLinkAboutMortgage_Hawkins"^n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• Stale Fortn 43709 (R11 / 6-09)
� 1 PresaiGed by Departmefrt of Local Govemmenl Firence .
�NSTRUCTIONS:
To be Red in person or by mail with the CountyAuditw or Counry Recorder of the counry where the p/operty is loc�V 1
Fili'g Dates: 7) Real Pmperty: Must file during the yearlor which the deductlon is sought.
2) Mo6ile /Manufactuied Homes not assessed as Real Property: Must ne dunng the IweNe (12) month
6efore March 37 ofeach year the deduction is sought , C����
See reverse side !or addifional insVUUions and qualilicafions.
q����{ (oirreioroormarl6uyer-�se�e onm�ntrsesde) � '�/ � p� U
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County AuditOr
Caunty�Remrder
- �' a�-��=o - yo _ 000. 3 9 3- o a 1 "'1 l
ed ra4ie U real PeP�Y as of Morlgage / ConVart'ude6tetlness unGaid a W Mongage / ContraU mtlebteCrMss unG� az d Is Ne ePP�t tice sde
1. armnt ym Ma`di 1. artent yem date o( appGCation legal ar equilatle ovmeR
95.697 ❑Y�❑No
If ro. what ¢ Itis l her eza�Y sl�ara o( intemst?
If rwrie m mmrd'b 6Rerent Ihan Nat o( aPP���. uM'uate Gebw.
Name of imtgagee «mnbaG seller� (�
l 1 / � � �
Address o( rmt�agce or contrad se�er (numbu aM str.
Name o( assi�ee w ahrl oxner or holEer of mortgage
Atltlress oj.qssgnce (number aM stree4 �1: sfare. end.
N _3
Dces applimnt own yoperly in any oNer If yes, x+.:
counry in IMe�u? ❑ Yes
❑ No
Oeaucaon aowoved m the amount of:
If awned wiM someo�re oNer C�an s�ousa, inAicate uiN whom
Dra�der NO.:��'..:.......
' �) {�
CaCd NO . p.....................
�t95r1�l5. pb— _
,
mnM WhatTari�mDat+iC?
COUNTY AUDITOR
Is IM property in Ques6on: Mnua0y0.ssesseE
I_I.ReaIP�vPeRY ❑A"^�Y�
Mo61e Flarie (IC 6
Has Na Eedudm Oeen reGUested m DmpertY
tw anmt yean ❑ Y�
❑ No
20 20 2q 20 _ 20 _ 20 20 _
��nne W r.ounbAWiwr Counry Date (monM. daY•Y��
C — �
I I We certify uMer Ne penalry M ury that the a e and foregoing intomiation is W e and cortect arM that Ne applipnt is a resident of I�iana aM
owner I mntracl buyer of the aforementioned pro on date applintlon is filed.
�naty�e (owne/s hAriartre� � �% Date (nmth. tlaY. Yeah
ti
dry state, ard ZfP ootle)
auttnrtretl Dy Ouly executeG Power of Atiomey m by IC 61
MEress oi auU�or'¢ed persm
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