HomeMy WebLinkAboutMortgage_Hall (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ � FOR DEDUCTION FROM ASSESSED VALUATION
• SUte Fo(m 43709IR71 / 6O9)
S � PraaibeE by DepartrtreM o( Loral Govemment F�nce
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�lSTRUCTIONS:
M:
To 6e filed in person w 6y mai/ wifh the CountyAuditw or Counry Recorder o! the county where the property is located.
Pil'mg Dates: 7) Real Pmperty: Must fife durirn� the year /or which Ne deducfion is sought Counry Audimr
2) Mo6de / Manu/actured Homes not assessed as Real Pmperty Must fi/e dunng the hveNe (12) months , R, QountP��Order
befae Ma�ch 37 of each year the deduction is sought. ��' q
See reverse side lor additiona/ instructions arM qualifications.
AooGnntfownara'oorUtadbvYE/-seerest+kl9CSmreverseside) .n � . � . i w _ . .
1,
If m.
�
ney wi a eacOl �V�•OO � OW / L L OS �
y poperty a u1 Alortaape / Contraa indehted�ss unpaitl a of Mwtgage / Conract inEebtedness unpaid as of Is Ne eppGfant fhe sole
� Mart3�1 w nyyer dateafappGcation Iega�oreWitaNeowne!?
S `
❑ Yes ❑ No
u emct share of intrmst'+ If ovmed wiM sorneorie aher ihan spouse, iMicate with wlwm
EMemnt fhan Nat o/ aPP��t mtlilate below. Is ihe PmPenY in questim: MnuaDy ASSesseO
❑ Rea� P'oaertv ❑ lvmualh As�sed . . .
Name M mortgagee a cantract se4er
AGdress of mort9a9ee a mntract sellet (i
Name ol assi�ee w other avmer w holdi
AdCress of assignee (number a�M avee4
Does eppFqnt avn property in any aher
oounryinlnBuna? ❑ Yes
De�ucOan approved in the amoun� of:
20_ 20_
SigfaLrte of Couny Autlitor
and streeC �Y. sfate.
ciry, slate. arAZlPCOde)
�_
YJhat Tari�g Distritl? Has ih's di
for artent
GOUNTYAUDROR
20 _
Co�nry
C�
r�
sted on propeily
Yes ❑ No
oa�e (rrnntl�. day, year)
20
I/ We certify under ihe penalty of perjury that ihe above and (oregdng infortnalion is W e and correct a� Nat the applirant is a resident of Irnliana ard
owner I contracl buyer of the aforementioned property on date applicatlon is filed.
,.,.�,..e i.,,.,..e� nai ��,.a� Date (rtw+fi, daY. YBa�
�Y
state, aM LP ootle)
of Avomey or by IC 61.b12�J
Pddmss of auttrof'ved pnrson (numbrrarid sUee4 �: s+afe.
'_ Date(monlh,day_yea�