HomeMy WebLinkAboutMortgage_Hughes (5) S STATEMENT OF MORTGAGE OR CONTRAC DS County Township Year
FOR DEDUCTION FROM ASSESSED VALUA1
D BE
f�t State Form 43709(R77/6-09) 1
Prescribed by Department of Loral Government Finance 6 20`�
ti,
APR 1 File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Aud for or County Recorder of the county yyrl'ere•tt�Yri11„�. is located. Form Ned
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sou.S i: (TOR ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must s- . meta iR/1l2)months
before March 31 of each year the deduction is sought. GIBS• ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner orco r(bb r-see restrictions on reverse side)
Tap D' Key num r/legal description Record number Page number
An)?'Vine —/c7 6 -� -07 i r 0033790 1 - 0{00 9 .1/ 05
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,y�rent year date of application legal or equitable owner?
(0 � 3 Q.,
0 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than spra iw,indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgag or tract seller
Addlea4 of mortgagee o tract seller(number and street,city,state,and ZIP code) I n- 2 -_ __ — - - - -
Name of assignee or other owner or holder of mortgage (.Y(b a )�- Lti l
Address of assignee(number and street,cdy,state,and ZIP code) X065
• Drawer \0...'.•••
............
Does applicant own property in any other If yes,what county? S 1 on property
county in Indiana? ❑ Yes ❑ No
❑ No
Card NO. .... .......
COUNTY A__.._.. - '
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
nabro Ys full name) Date(month,day,year)
Full resides address ppf 6t2 state,a •ZIP e -r
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 .. Date(month,day,year) t1I�\\
Address of authorized person (number and sneer.city.state,and ZIP code) \.