HomeMy WebLinkAboutMortgage_Hill^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ + FOR DEDUCTION FROM ASSESSED VALUATION
� State Form 43709 (R71 / fi-09)
4' j Presaibed Gy Departmerd ai Loral Govemment Finarce
INSTRUCTIONS:
F
To 6e filed in person w 6y mail with the CountyAudifor or County RecoNer o/ the county whe2 the property is located. 1
Filirg Dates: 1) Real Property: Must fi/e dunng the year for which the deduclion is sought. Q U � y
2) Mo6�7e / Manufactured Hwnes rrot assessed as Real Property Must file dunrrg the hveNe (72) months
befwe Maich 37 of each year the deducfion is sought C.'�.
See reverse side 7or adtlitional insWCtions arM qual�cations.
e...r.����i.,�.,.,e............�,.re,...e._�m.n.r,.-r....�.,...e„e2e..ue� � _ nrunn��
�������
�darU 7, anent yrar
� rw. what is his! her euct share ot interesY?
an
Name of rt�ortgagce or mntrarl si
Address of rrongagee w cantraq
Rounty Auditor
Counry Remrder
7� -'..•• n�uilVK
desoip � Remrtl number Page numGu
, g o_000. v8 �-o �S' I 3 9
3e / Contraa indebteCness unpaid as af Mortgage l Cmuacl iMebteEr�s ispaiG as d Is Ne applxant Ne wk
1, wrtent Y��1 3 5 �,s Eate of aPP�� legal or equitahle v.me(?
1 ❑ Yes ❑ No
If ovmetl wiN someone other than spouse, iMimte wiih wfam
te 6ehw. Is e P�OertY in puestion: Mnua%' Assessetl
Real Pmperty Q NmuallyP5ses5ed
end sbee4 �2Y, sbte, aM ZlP cade)
Name ol assignee w oNer owner w holder of mntgage
i��� e� �e{
�
uaperty in any oNer
oaa�� a�a � me a�,m �
�
:�.irr.uzm�li[.� �
Dra►ver i\'0.....aQ� �
Caf'(i 1���. .. �l5/ 1 ..... ..
�3•S,•� .�......
r 5 (5t�
zo 2o zo 2o zo zo _ zo _
Signahue W b Auditor Counry Date (monM. daY Y��l
�.T
I I We certify ufWer ihe penalty of perju t Ne above foregoing in(ortnalion is We and cortect arW that fhe applicant i5 a re5ident of I�iana amf
owner / wntract buyer of the ahuemen ed property o date apPlication is filed.
dry state, and ZlPCOde)
Pason aWmrrzed by dWy ezeated PawerW �ivneY w by IC Gt.7-12-0.7
Pddress of auNor'¢ed person (numberaiM sbeef, cily, stdfe, arW LP mda)
�