HomeMy WebLinkAboutMortgage_Henson (4) a :�.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coup f�'y�jia i.SE'jE11
�t FOR DEDUCTION FROM ASSESSED VALUATION '� AIM
SUM Fonn 43709(R127o-la) �
Prescribed by Department of Local Government Finance
J -I Ii
INSTRUCTIONS: '
To be filed in person or by marl. Fain aka win
Filing Dates: r) Real Property.Mush be completed and dated in the calendar year for which the deduction is sought /
Must be tiled or postmarked with the CountyAUdta Or Count'Recorder of the county when Slit is I r 71 'r, rrtr .;,a
located on or before January 5 a the immediately succeeding calendar year. �+tBSON ,�]Jtgatjrgyry;§Cg jR
4 Mobile/Manufactured Hones not assessed as Real Property:Must®e with the County Auditor of the county
when the property is located dining the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
7in�"la� mer errand buyer-aft!n Ierse Ode)
`A'' son OYnri NN 1�U�(? kr']-�. rr
Tadrhp Di Key iaxnberltegat pi, Nbil 5C /LI. Record Page msaw
it ne�f 26- 11'2o- 4c0-ool.52s-021 20- -12 It'-Wdod
Assessed did as of Mortgage/ indebtedness u�m as of PAN ngagContract iircettdness unpaid as a l applicant March 1.cave year C � the
iVOt51.L�,
❑ Yes ❑ No
II no.'what Is Ns/her exact share of interest? - IT mined with someone ogler than spouse.ildcata with whom
t .t
�U name on record is different than that of appll ard.indicate below. is the property in gueston:Annually Assessed
V\.lJ'()QXI� MOe ard FieQt k vv.. ❑Realpmpeny ❑
Wade MM1.1-7)
Aoo tcaQ imi), ttxi 49ee TN �6o`E and ZIPcode)
Name of assignee or other owner or hater of mortgage
Address at assignee(number and meet cry,rate.and ZIP code)
Does apdgoad own prapeny It any U yes,what toady? I vi hat Toying Distia? Has this deduction been requested U yea.stale amount of deniaan
In
other Ma ❑Yes ❑No
CO Progeny year? ❑Yes 0 No
A person is not enblled to this deduction unless the person has a balance on the person's mortgage or contract imfebted?ess that is recordedln the county
recorders office(including any)lane equity line of craft Nat is recorded in the county recorders office)that is the basis for the ded aio n.
COUNTY AUDITOR
Deduction approved In the amount oh
20 20 20 20_ 20_ 20 20_
SMyuhre of County Auditor Canty Dale(nodq day.seen
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 i
owner I contract Wye of the aforementioned property on date application is filed.
BiNatun(amen AS name) Data(montn,day.yew),
X b 4-1a— (L-
FlLresIdent lapel t=dl:urrLer and street cy,stele,and VP Ode)
3213 S. 1O5o W j Qwena al) N
410495"
Person W.horuN by duly exeaned Power Of Attorney or by IC 8-I.r.t2.0.7 Dale(nosh.day,yawl
Address Of whited person (number and dint,dry:state,and ZIP code)
The penalties loperryry can rrltlude impisoanenl up to No and a had years and a fine not to exceed$70.r>o0. .
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