HomeMy WebLinkAboutMortgage_Anderson^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_, FOR DEDUCTION FROM ASSESSED VALUATION
- • State Fortn 0.i709 (Rt t/ 6-09)
�' Preuri0e0 M �ePart^ie�n af Lad GovemmeM Finance
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To be filed in person w by mail with tlre CounryAuditor w County Recorder of Ne caunry where the property is bcated.
Filing Dafes: 7) Real PropeRy: Must �le durirg the }rear /or which the deducL'on is soughL � E j
2J Mob�7e / Manufactured Homes rat assessed as Real Pmperty Must file dunng Me tweHe (12) months
before Maich 31 o/each year the deduclion rs wught. ��i
See reverse side ditional ins e d q alfi tions. !/'��µ
v
tldLhry Auditor
Counry Recordes
,••s•= 'i�ii�il.f'L' /:` Nlib`7�P1lTl1�4��.�.-'�.
Asessed vahr d� P�OeRY a of
Me'd1 1, anvC year
If ro. what Is tus I trer exaa sha�e ot u
If rartre on 2mN's 6IIern�t Man tha
Name of rtartga9ee a mnttact se9er
Address of nnrqagee u contracc seA
Name af assignee w aher ovmer or 1
neaan or
�,.�,,,�,,�e�;°�'v-a� ! c�o-boo. a6�i ow� a P�e,� �
Mortpage / �[ inEebteOrrcss unPeid as ot Mongage / Cantraa'vdeOCeCnPSS un0� az d Is Ihe eVP�^� Me sok
Mam3� 1, w�i�t dar �� date of appOptim �� ❑ ❑
U�j Yes No
If ovme0 with samearre other than spauu. i�imte wiN whom
h�Ei�am beb.r.
shee4 cGy, sbm, �aM LP code)
mortpage
MsveeL �Y. smte. ^•,w.�iaminl_
Dra���er NO........
a�Y �„� .�i i� I Gy. . . . . . . : ..
Yes ❑ No
Cai•d NO. ...!-is.�`.�.........
Deduc6on aPPrwed in Ure artaunt
h Ihe pmperty in puestim: MnuaAy Asressed
� Real PfoPeNY � %��!�Y �
�16
p_ I Zp= I - I _' I _-- ' 20-
1 / We certify
s�a a, a�v�r
Yes ❑ No
�
Counry Data ( ay,
' ' /�
of perjury that e ahove and toregoing intomiaUon is We and cortect arW Nat ihe applicant is a resident of IrWiana a�
oremerrtmed erty on date appfication is filed.
ll I / r � oa� lmd+m, der, r�1
� �i�,�..J 9' I �1 —/�
Cmss of appGeant (wmEer anE sLeet ah5
i � E 90o S �
xa M a�dr �ewcea a�c«g ornnamer or �
of eWw�'ved pusm
sbte, eM LP
/
��m. aay: y�
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