HomeMy WebLinkAboutMortgage_Hasenour�.._^—�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townshi Year
a�w' ° FOR DEDUCTION FROM ASSESSED VALUATION
''��`�i ' S1 2
3� � State Form 43709 (R71 I 6-09)
�'•�%'' Presaibed by Department of Local Govemment Finance
�ei.
�TRUCTIONS:
o be filled in person or by mail.
Filing Dates: i) Real Pioparty: Musf be completed and dated in the calendar year7or which the deduclion is sought.
Must be filed wifh fbe Counfy Auditor or County Recorder of the counfy where the p�operty is located
on or be/o2 January 5 0l lhe immediately succeeding ca/endar year.
2) Mobile / Manulacfured Homes not assessed as Real Property: Must file with the CountyAudilor o1 fhe
county whe2 the pmperty is bcafed dunng lhe 6velve (12) months bePore March 31 of each year the
deduclion is soughf.
See reverse side !o� additional insfruclions and auali�cafans.
or contract ouyer- see restncnons on reverse
J. Hasenour and Sarah M. Hasenour
�;� ��-��o�
F�sessed value of real property as of
March 1, a❑eni year
If no, what is his / her ezad share of inter
If name on record is difterent t�an thai of
Name of mortgagee or contract seller
Fifth Third Mortgage Company
Address of mortgagee or cont2ct seiler Q
1 Kingsley Drive, MD#1MOC E
,e of assignee or oNer owner or hald�
Address of assignee (number and street,
Does applitant own property in any o�her
� wunry in Intliana?
❑ Yes
%
Key number / legal description 26-1&31-400-000757-009 / Property
Address
702 E Laurel Ridge Court Haubstadt, Indiana 47639
PIN
26-19-31-400-000.757-009
as
i, wrtent year
,800.00
Cincinnati, OH 45263
of ap0�ication
someone
Form filed with:
��'�iq'Auditor
�� � Co�i ni�ecorder
number
��—`f /� /
number
! indebtedness unpaid as of Is the appliwnt the sole
legal o eduitable owneR
�Yes ❑ No �
han spouse, indiwte wit� whom
ne property in question: Annualy Assessed
Real Property ❑ Annually Assessed
Mobile Home (IC 6-7.1-71 ,
yeaR
on property
Yes O No
COUNTY AUDITOR
Deduction appmved in the amount of: __
20 20 _ 20 _ 20 20 _ 20 _ 20 _
Signature o( Counry Auditor Counry Date (month, day, yea�
I! We certify under penalty of perjury that the above and foregoing information is We and corred and lhat the applicant is a resident of Indiana and
owner / conirect buyer of the aforementioned property on d p� tion is f led.
Si nature (owner Ilname) / Dale onth, day, yea�
� 8 2
ul esitlen d r ss of apPlicant (num6e� and s(reet, city, state, an e)
702 E Laurel Ridge Court, Haubstadt, IN 47639
Person authonzed by duy e.ecuted Power of Attomey or by IC 6-7.1-12-0.7 Date (monfh, day, yea�
Address of authorized person (number and sfreeC city, state, and ZIP code)