HomeMy WebLinkAboutMortgage_Hensley^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
4' I PresaibeE by OepartmeM of Lad Gwemment Fnance
a
�1STRUCTIONS:
7o be filed in �
person w by mail with fhe CounryAUditor or Counry Remrder o/ fhe counly where the property is located.
Fifing Dates: i) Real Pmperty: Must file during the yearlor whirh the deduction is soughG � County Audimr
2) 6efore March 37 0( � year Ne Aeduction is sougAtruperty Must file dunng the fwefve (72) months AP�72 80����
See reversa side !or additional instrucUons and qualifications. � 1��,�
As�tud rehce af �
MaiCh 1, aaR�V yPar
If ra, whal a his / he
m
dMuent than ihat of appfrant'o+dkate Ceb�r.
Name of mon9a9ee ar mntraG se�er
AAaress of mort�a9ee «contrsn se0
Name of assignee w ot7re1 awner or 1
oi vqrtgage
-ovc�• y� a
udebted�ss unPaitl as d Mongaga I f.ontraa mde6ttd�s �mPaid es d Is ihe ePP�� tlu sole
�L date of aOP�� kgal or M���Ne owne/!
� ❑ Yes ❑ No
If ovmeC wiN someo�re oNer U�an spouu. iMifate w%h wtwm
Is Me property in v�^: /'+�nually A55es5e0
_ r�'eal Roperty ❑ P.rmuallyAssessed . . .
ciry, state. aM ZIP to0e)
ACdress o( as99nee (n�m6er ard svee4 mY. �e. sM LP code)
Dpes apdi�ant ovm poperty in any other I( yes. wfie
��h������ ❑ Ye5 ❑ No
\
\
WhatTa�dn9 Disvirl?�.
COUNTY AUDROR
�
P�WP+�Y
❑ No
durlion approved'o� tha artnunt ot %
20 _ 20 _ 20 20 _ 20 _ 20 _ 20 _
7�awre ot CounN AW imr Caunry Date (monN. daY• Yea�
I/ We certify under the penalry of perjury that ihe above afW foregoing in(ormation is We and cortect and that the applirant is a resident of I�iana arul
owner I contract buyer of the aforementioned property on date application is filed.
..,.,�...e i,....e.t na,.�,.mi Date l�onfi, daY. l'ea�
�eM aEdress of appGnnt (^num0er anld 5bee4 dty, sfate, aM F mde� y � bb S
� �%� � �A JL/1'�A.l..� � �
Person auflro�¢ed by duly exewted Power of Atlomey or by IC 67.7-t2-0.7
AGEmss of authw'ved pus«� (number aiM shee4 dry. sble, and ZIP oode) .
Dare (month. daY.