HomeMy WebLinkAboutMortgage_Henson (2)"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEdAE� oun Township Year
• FOR DEDUCTION FROM ASSESSED VALUATION
•r�� � StateFwm0.i709(R71/6-09) DEC 1 0 201
�' � Presrnbed 7Y DeP�N of Local Govemmen[ F�
�� C � � � File Mark
INSTRUCTIONS:
To be filed in person or by mail with the CounryAudito� or Counry Recorder of the�BR��p(IlA�p� �y�, Fortn Aed wiw:
Filirg Dates: 7) Real Property: Must fi7e during the yea� for which the deduction is sought. �R County Auditor
2) Mo6de / Manufaclured Homes rrot assessed as Real Property: Must fife dunng the hvelve (72) months
6efae Ma2h 31 of each year fhe deduc6on is sought Counry Recorder
See reversa side for addiUOnal instrucUons and qualifications.
I AooGlant fowrrer orrrntra� buver - sea reshitOOns ai 2v2/ie SideL
Assesse0 value of real pfaperty as ot
Mamh 1, ame�il yPat
num6er / legal desaip
�-I - 3 - o0 1 .�
A�tgage / Contrart'udehtetlnPSS unpaid az of
lAardi 1, airtent yeer
rc ro, what k his / her e�act share ot inturst?
if �artie on rcmd "a SittuPnt Nan Nat of a0p[
Name at rtnrmaoee or contrar� seAu
ot rmrtgagee w oontraG se0er (nunbrJ and svee4 �Y ��. � LP code)
Name oi assi9r�ee w othrl ovmer or h
Ad7mss of as9qtree (numbrl arM sfre
Does applimnt own property in any otl
munry in Ind'ona?
❑ Yes
Dafuction avomved in tlx amount aY.
20_ 20_
itlne W Camb P�udi;or
mortgage
m
:�l
� appGranl iha sole
W eqUilaNe avme(/
❑ Yes ❑ No
ppny m question: MnuaOYASSesseA
P(operty ❑NNrt»ua11yA55essed
sfate.eMLPa � . �{�I� � '.1
V ..
. • �Dr•a���er NO .....)..............
I ND It Yes. '' �/ /� iiv deduQion Deen re9uesteE m P�Y
:rentyeaR � Yes ❑ No
Cai-d NO . ....................
20 � 20 � 20
20 _ � 20 _
�Y• Y��
I I We certify urWer ihe penalty of perjury that Ihe above aM foregoing infortnatlon is We and correC arM that Ne applipnt is a resident of Ind�ana aM
ovmer ) mntract b�yer of Ne aforementioned pfoperty on date applkation is filad.
' � a\h�U�CL h�,� _ i�n �� o��^ �y�rea� ��_
(number antl sbee4 �1; �te.
eyawy
person (num0er arM sbee4 tiry. slafe. aM LP cade)
Da[8 (rtpnth.
�