HomeMy WebLinkAboutMortgage_Hensley * . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township Year
bLa ;, FOR DEDUCTION FROM ASSESSED VALUATION
7.3- `'S State Form 43709(R11 I/6-09)
Prescribed by Department of Local Government Finance
irr. i
INSTRUCTIONS: F +
F. - —
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is ted.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months A. G -2 o[7ounty Recorder
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant(owner or contract StI ,.,tee restriction reverse sI.7e.)
I�XJ� ' 1 GIRSQN COUNTY AUDITOR
Taxing District I�a�' 06-a OD - CO 0• 6 55--0 I I' r P735I
Assessed value of neat property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the
March 1,current year March't rent year date of applied
can legal or equitable owner?
, El Yes El No
If no,what is his/her exact share of interest? It 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
y J A I I ❑Real Property ❑ale Home Assessed
1.1-7)
Name of mortgagee or contract seller (� (� l� V
Address of mortgagee or contract seller(number and street,city.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
$p"-en9y A. itR uyQr „ - - - -
Address of assignee(number and scree;ray:stata,and ZIP cede
Drawer NO..aol 7
Does applicant own property in any other If yes,w ...•.• ........ ductal been requested on progeny
county in Indiana? ❑ Yes El No year? Yes ❑ No I-
•
Card NO 35 I I
Deduction approved in the amount of. 4695,cco. •• .. •.
20 20 20 20 20 1 20 20
Signature of County Auditor County Date(morph,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
own-r/contract • rt.of the aforementioned property on date application is filed. .
Date(month,day,Yew)
if.1017
-
F e? nt...._- .f:.,. t(number and street tray,state,and ZIP code) _
0i 9 etA ark- Lf !!>'.Qn. 4i635
• auuorired by duly executed Power ofAdomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)