HomeMy WebLinkAboutMortgage_Hanks^'� STATEMENT OF MORTGAGE OR CONTRACT���� Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUA N
• Slate Form 43709 (R71 / 609)
�' PresaiEed by DepartmeN of Lxal GovemrtreN Frence
� OCT ] 9 ZDi� File Mark
�STRUCT70NS:
Fortn fted wR�;
To be filed in person w by mail with the CountyAurlkor or Counry Recorder of the count�wfj� is located.
F7irg Dates: 1 J Real Pmperty: Must file duriig fhe yearlor which the deductbn is soughc �� Counry Audiwr
2J Mo6ife /Manufactured Hwnes rrot assessed as Real Property Must hle durirg the hvelve �nths
beforeMarch37ofeachyearthedeductionissought. G�gSONCOUNTYAU ❑ CounryRecorder
See reverse side for additional instructions antl alficafions.
Ma���(owrierorcontra -see ��� � W M"`+
T istrict Key rwmher al tlesaiption Recotd rw Page wrti6ri
_ / - =a ou �o . 8 -oa z3 �� d5 7 3
As�uE vah�e d mal properry as d Abrtgage / Contrart "uMe6tetl'ress unpaitl as of Mortgage / ContracY uMebtetlnrss �mpaitl as o( Is Ne app6rant Ihe sole
�Vamh 1, tlmMrt'/ear MamJ� 1, wrte�rt Yee��� /�� date of aOP��b^ �� O�e O
If m, what is his / her erafl share ot interrst?
If rwne m reond'a C'iRuent ihan ihat W aPpO
Name of rtbrtgagee or mntracl se�er
If owneE wiM mmearie other than spouse. irdirate with whom
ts C�e WoDertY in Question: MnuaDy Assessed
❑ Real ProPenY ❑ ����b �
rtnrtgagre w wntrad se0c (nuMer ad svaeG ctiy. sbte. aM ZIP code)
w other owner or twlder of mort9age
AdCress ot auignee (number aM stree4 �Y. s/a[e. eM ZIP code)
Dces appliraM ovm P�oDenY in a�ry dher
munry m Ind'vna? � — .
P t�c �+ K QisT�-
��_�,s�3
Has Ni5 deduCion Oeen repueste0 m pmprity
� W� � ❑ Yes ❑ No
couNn auoROR
za i�_ i p— i p
�� ��.
I I\ _..� ye�ury that the above and foregoing infamaGOn is trve and cortec[ and Nat the applicant is a resident of Indiana aM
owi _,.,�aci ouyer of ihe aforemenlioned property on date application is file0.
eaW lowneCs lutl �m� „ . 1 . . Date (mwtlh, daY. Yaeh
Pe�sm aWroraed Ey EilY exi
Address ot auNOr'¢<.d persa+
slare, antl ZlPcode)
by IC 61.1-12-0]
stree; dry, state. and Z!P mtle)
�Y. Ye�