HomeMy WebLinkAboutMortgage_Hopf (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEB � C n Township Year
:. _ .
FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fwm 43709 (R71 / 649)
�' ' j presaibed by Department o1 Local Goremment Flrance
"" SEP 21 File Mark
INSTRUCTIONS:
To be filed in person or by mail vnth the CountyAuditor or Counry Recofder of the counry where the prupsAyis4'"� `' F� �� ���
Frfi'g Dates: 1) Real Pmperty: Must file dunng Me year for which the deduction is mught. `— � J� �� �p �unry Audiwr
2) Mo6ile / Manufactured Homes rrot assessed as Real Properry: Must file dunng the hveNe (12) m nt�p�'f C }�
6efore Ma/ch 37 of each year the deduction is sought �OUNS� � LI County Recorder
See reverse sida 7or addiUona/ insfmcGOns and qualfications. C'�gsO�
I AppG�nl�(ownerQr mntr�t 6uyer- see fes4iUions�un revzrse side)
�� i vu,va a —
Aae�eO�ahredmaiP�W asot I
Mad� 1. w�ent year I
Mad
tt no, what a his / icer e�ct sha�e of interesl?
If name m rem�tl is dilferent Nan Nat of appGran4
Name of morigagee or conVaG se�ler F
�- o a o00 'y/ v a �
�/ Contrarl "uWr�tetlnrss unpaitl as d Mortgage / f.antracl udebteMess unPaiE as of
artent year Eate of appGntion
�mrtgagee w contratl seller (number aM svee; city, state, aM ZIP code)
signee w ahu owner or holder of mortgage
Adtlress of assignee (num6er aM sbee; ray; s/ate, an0
Does applirant own property in any oNer
counryinlndiana? ❑ Yes ❑ No
De�uction appm�ed'ci tlie amount oE
20_ 2b_
Sianature of CounN AuOimr
yes, wnat wuntyt
�o��
It owned wrth saneone aiher Nan sPOUSe.
Is Me property in QueStia
❑ Real Pmperty ❑
{-�P �� '��
�����
Id��ly��
20 � 20 _ � -_
Counry
Pege number
Yes U No
AssesseE
�,es�ea o� a��a�r
20 � 20 _
yea�
I/ We cerlify under Ne penalry of perjury that the above and (oregoing infortnalion is We and cortecl and tha[ Ne applicant is a resident of Indiaria and
owner I contrad buyer of ihe aforemerrtioned property on date appiication is filed.
I�etum.{9�fs hAn�ne) _ Date ( nnrvh. daY• yea�
and sheet tlry, slate, ard LPcade)
If
Peison au�E Gy dWy ezewtetl
lddress ot auNatrcO puwn (numDer arW stree4 �ry, sYdte, aM LP code)
Date (monlh. daY. Y��)