HomeMy WebLinkAboutMortgage_Hurst (9)^�+ STATEMENT OF MORTGAGE OR
_ _ POR DEDUCTION FROM ASSES:
. ' State Fortn 0.9709 (R71 / 609)
1 � Hesa�bea M OeP�rd of Local Govemme�rt Fiiwio_
"" Vl.l GL �V�L
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To 6e filed in person w 6y mai/ with Ne CountyAUdrtw or County Rernrder o/ the counry whe2 �' perty is located.
Fdirg Dates: 1) Real Property: Musf file during the year (o� which the deduction is sought. V
2) Mobde /Manu(aduled Homes rrot assessed as Real Plopel[�3fA1gt� du(i�.Ua�f�fvg (12) months
6e(o/e March 37 oleach year the deduction is sought. U�TUFZ
See /everse side lor additiWnal insWCtions arM qualificafions.
�,�d�,���
AfarU 7, arre�rt year
trt
tr ro. what Is hs / her exatl share ol
If �urtie m remtl a E'iRels�t Uun tt
File Mark
Fortn f�ed with: �
� Counry Auditor
�❑ counry Remrder
Key rnmbe(/ le9al OeuriPtion ' P nu
a�- -/8' -3o a o� /. a 7/ 0�8� ��J 6�Y .E
MoRgage / Contrau irWe6teCness unpaid as d Mwtgage I Contracl udebtetlnass unpaiA as o( Is ihe aDW�i Me sNe
1 rrt date ot epp0�tion legal w equitaWe rnmeYt
Q � ❑ Yes ❑ No
teiestl If owned with someone oNU ihan SPO�. udirata with whom
of appOmn4 md"uate Cebw: h IM property in Question: MnuaDy A�.sessed
eal PfoPeRY ❑ ��Y �
Nar e�ee« seller
�
Addres of rtart9a9� ar mntrxt seder (nurt�ber end sbee4 uN state. ard LP code)
Name of assignee w other ownet or twlder W mortgage
AOtlress of azsignce (n�mber and stree; dry. sfate, arM LP catle)
3&ant ovm pmpeny in any other
�,�g�� ❑ Y�
Ogluction apprwF.�d'e� tlia amount oF.
r.n
If yes,
COUNTYAUDROR
�
ao�.� ..... —
D��"���\��
m
y9 y.� ..::�.2Y � No
C��_d �p, ... � 5r�,0ag' � —
20 20 20 20 20 _ 20 _ 20
syrawre w co�mry nwiwr counh oa�e (�o�rtn. dar. r��
I/ We cerGfy ufder Ne penalty of perjury Nat Ne above antl foregoing infortnalion is We and cortec[ and that the appiicant is a resident of I�iana aM
owner I contraa buyer of the afaementioned property on date appliratlon is filed.
wNOiaed
aTy, state, eM LP aode)
person (numberaM sheet, tAy,
aay,
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