HomeMy WebLinkAboutMortgage_Hull^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
. _. FOR DEDUCTION FROM ASSESSED VALUATION
�• Stata Fom� 43709IR71 ! 6-09)
�` f Prcuri6ed by Depanmenl of LoW Govemment Frence
� File Mark
�sraucnoNS:
Fwm f�
To be fiied in person or by mail with the CountyAuditor or Counry Recorder o/ Ne county where the pmperty is located. �
Fiting Dates: 1) Real PmpeRy: Must file dunrg the year fo� which fhe deducfion is sough[ Go ` dimr
2) Mo6de / Manufactu2d Homes rrot assessed as Real Prnperty Must fiIe dunng the M�efve (72) months �
before March 37 0/ each year tha deduction is sought. �^h' �
SeereversesideforadditionalinsLuctionsarrdqualifiwtions. ONCOUNTYAUDIT R
MWram(ownerar Cbuyer-serKestri^,a�son�eversef`�9i . _ � 1 1 _ �
�ern yrar
's his I her e.xart sha�e of interest?
on remtl s 6Rerent lhan Nat o( aPP�4
Name of rtqrtga9� a �nvarl
�-a►a-�u�—vcx�. �
hBew� �C� ( I�Oazof
l�J
Address of rtnrtqagce or contraU se0er (number and streeG �}: state, ard ZIP code)
Name of assignee w oiher owner or hdder of rtortgage
/
ACtlress o( a.•,si9nee (number aM speet �Y. �te. end LP cotle) �
Ooes appliont rnm properry in any oNer
counry in Indiana? ❑ Y�
I
Deduc6on approvad'm the amount ot
20 2b _
Sigrunne NCaunbnWaor
r�
Counry
20
Remid numher
mdehtedness uri0ai0 as d I Is iM ePp(xant tha sole
legal w equitable avmM
❑ Yes ❑ No
spouu. i�imte wM1h wlwm
�s me wavem �� a�,: nr��oy wssessen
❑ Rea� RoaeM ❑ %vmiraM.Assessed
Has Nis deduCirn Deen
for cu�rent yraR
20
�Y Yea�
an p'openy
❑ No
20
I/ We certify under Ne penalry of perjury that the above and foregoing infortnalion is W e and cortect a`M ihat the applicant is a resident of Indiana and
owner I wntracl buyef of the afwementioned property on date applintlon is filed.
��gwre (my�sn 7un rwne) • _ .��% � � ../ / / .�� �// ♦!_A� o-ate (m«,tl,. dar. raa�
Pusan autho�a
of
aM
by IC 61.1-12-0.7
person (num6er and sbec; dry, stafe,
Date (manlh. daY• Yze�