HomeMy WebLinkAboutMortgage_Hurt (2) rSTATEMENT OF MORTGAGE OR CONTRACT INDEg fNiSS I 4: rj�p Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Font 43709(R11/6-09)
Prescribed by Department of Local Government Finance
MAY 13 2013 File Mark
INSTRUCTIONS:
Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county wises- r e pro.-m is . -ted.
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought t`,I, •�Ar11Ni i ths I�QJCOUnry Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Mud{ "it. - /J`—'
before March 31 of each year the deduction is sought • ( • N AUDITOR 9 County Reorder
See reverse side for additional instructions and qualifications.
AppSnnyt�wnererwpyonyayrr �8 �—�p/,� 4 ,/ ��-F( I
Tapry6Cj3tri[c.[�l�A��04 Key�rm�er / w —3 3iX`/ / /amber P D0
Assessed value of real property as of (p Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appGrant the sole
March 1,carat year Martli 1, t ye '"'o date of application legal or equitable owner?
o ar f ❑ Yes ❑ No
If no,what is his I her exact share of interest? n owned with someone other than spouse,Indicate wNn whom
If name on record s different than that of applicant.indi ate below Is. the property in question:Annually Assessed
tr[Wr eat Property ❑Amwally Assessed
- ___ - - _ Mobile Hanle QC 6-1.1-7)
Name of morr�ageetpr se er _
Address ofLLyortgag• ee or contacct sselt1/er(number and street.city,.store.and ZIP coda) - _ '
U
Name of assignee or other owner or holder of mortgage COW _
Address of assignee(number and street cry,stare,and ZIP code) �U Fp �&t
•
Does applicant own property in any other If yes,what county? id / U3 at on property _
county in Indiana?
❑ Yes ❑ No !es ❑ No •
COUNTY AUDITOR
Deduction appnrved In the amount of
20 20 - 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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.
ere (s narrgf\ Date(rtonlh,day,year
resident address of appfrant(nu rand t cry.state,and ZIP code)
32_,f ,56 cv we YwZ c 0co Tti ri2Gf(9
wn authorrzed by duty ezecoted Power of a by IC G7.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street cd1:state.and ZIP code) -