HomeMy WebLinkAboutMortgage_Henico x . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
\,'_'" -=• Stale Fonn 43709(R11/6-09)
- Prescribed by Department of Lod Government Finance
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INSTRUCTIONS: 11 / wRRRRR
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. p''�V y
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought S i P L_ EYY-Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ Cou^LY Recorder
See reverse side for additional instructions and qualifications. ,���!_n
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APprrant(owner or contract buyer-fie restrictions on reverse side)
=SON Co UNTY AUDI TOR
Ta'�a Ire1'numberr!legal
•-• ddees. tlonn Record number Page number
•44S) /'" r �lP — Il o / —/00 — oo/• 798-oily / �/ 3S/a3
Assessed value of real property Ss of Montage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applrant the sole
Mardi 1;anent year Mardi 1,amen[year date of aPPfication 1 Iegal a equitable owneR
i � T d?O0 0 Yes ❑ No
If no,what is his I her exact sham of interest? If owned with someone other than sparse,indicate with whom
If name on record S different than that of app/Kant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home QC 6-1.1-7)
Name of mortgagee or contact seller 5/3
Address of mortgagee or contact seller(number and street,city,state,and LP code)
Name of assignee or other owner or holder of mortgage
Address of as ' ee(number and street,city,state,and ZIP code)
. f r w N&) 1 - of -ii //IC-
Does appfcant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for arrest year? ❑ Yes ❑ No
COUNTY AUDITOR - _
Deduction approved in the amount of: -
20 20 20 20 20_ H�,U1Co �CLt� r .
-,..of Canty Auditor. ` • County kit- •j —
1/We certify under the penalty of perjury that the above and foregoing information is true an
owner/contract buyer of the aforementioned property an date application is filed.
Signs, -(o full name)
A - i /, A.
Full I t •'t npgygaryl _ Li star and LP��Icode)
yyy-��' ��, I �� —
Person auNorrzed by duty executed Power of Attorney or by IC 1--12-0.7 (� Date(month.day.}'ear)
Address of authorized person (number and street,dry;state,and ZIP code) .