HomeMy WebLinkAboutMortgage_Hensley (2) �=_:-',
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
-- FOR DEDUCTION FROM ASSESSED VALUATION �
tt State Form 43709(R71/6-09)
Prescribed by DepamneM of Local Government Firence �I ,,t
File Mark
STRUC77ONS:
with:
be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form mad
to
Filing Dates: 1) Real Property:Must file during the year for which the deduction is soup County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must fid Ndin(ythe G4t3(12)months
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. ' • 4
_-if
APPrRanl(owner or contract buyer-see,�=!!:. on re - •rile) , 'nw•• q•nrryi
�, / ,
„EfilINTY AUDITOR
r Anatliksw.S.CJ( DVS ter/ 7-1a-- j3- �.�C {. (�W �/�`da Ramon]numprt Page� 0
Assessed value of real meetly as of e/CCC���t9raaact 4debtedness unpaid as of age/Contract indebtedness unpaid as of Is the appfcant the sole
March 1,current year Merdi 1, DOO of application legal orO itable ow tit
Yes No
If no,what is his/her exact share of interest? f If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller 1
Address of mortgagee or contract seller(number and street city,slate,aM P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city stare,and ZIP code)
. _ f
Does applicant own property in anv.+---- ry? • What Teem]District? Has this deduction been requested on property
county inIndiana?� ' for aurent year? ❑ wits
(V 14045'y' ,]uLy ❑ No
COUNTY AUDITOR
Deduct 4106K .
20 ' 20 20 20 20
I,
Signature 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 col•.ct buyer of the aforementioned property on date application is filed.
roar = h>e rte Date(month,day,year)
J�� t(nu rte — a— �.3
WI tad mess a f t(number and street .q(y state,and LP nmad�e)
• 4 D BeV L S-O owe9 5 JI t lP s/�l Lt'1t 1 Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,state,end ZIP code) .