HomeMy WebLinkAboutMortgage_Hyneman� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
FOR DEDUCTION FROM ASSESSEO VALUATION Coun Township Year
�s / State Form 43709 (RS / 4-03)
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� Presaibed by Department of Local Govemment Finance �� T' -�
f9 ?i d .� ��
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�INSTRUCTIONS: I�L � v File Mark
To be filed in person or 6y mail with the County Auditor of the county where the property is /ocate'd. 2��3
Filing Dates: 1) Real Property: Dunng the 12 monfhs before May 11 of the year the deduction is to 6e eHective.
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and Ma�ch,�/2 o(the yea,r'the.deductio/n is /f/o be elfective.
See reverse side for additional instructions and qualifications. `�`�`��'J�� `'"��-�-(
G.BSOf�CO' •�in;rn_ �
(owner or contract buyer - see
Assessed value of real property as of
March 1, current year
no, what is his / her exact share of interest?
If name on recard is different ihan that
of mortgagee or conlrad
tions on reverse side)
Key number / legal d
Mortgage / Contract i
March 1, current year
� O
znt, indicate below:
escripti�n Record numbe � � � / � �
b
6 a 9-� Page number
ndebtedness unpaid as of Is the applicant the sole legal or equitat
owne(? �i'S'es ❑ No
If owned wflh someone other than spouse, indicate with whom.
Is the property in q�on:
❑ Real Property ❑ Mobile Home pC Fr7.7
v/ �
ot mortgagee or contrad selier (number and street, city, state, ZIP
of assignee or other owner or holder oi moRgage
Address of assignee (number and street, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
counry in Indiana?
Deduction approved in the amount of:
20 20 �.i�_
�
Signature
Wha
couNrv au�
20 � 20 � 20
�
County Auditor
/ sted on
Drawer NO. Q 3.; �o� %7 .esO No
... .
Card NO . .....................
� 20� 20
� �
Dale
/ We ceriify u er ihe penalty of perjury that the above and foregoing information is true and correcl and that lhe applicants was / were
� resident of diana and owner of the aforementioned property on March 1, 20
re (owner's (ull name) Person aulhorized by duly executed Power of Atlomey
-� - n ��. - -- - --- — -- or by IC 6-1.1-12-.07
address of applic�nt �Address of authorized person