HomeMy WebLinkAboutMortgage_Williams (19)_�
.•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Stale Fwm 43709 (R8/ 2-07)
�0�;� � Resaibed by Depariment d Loral Govemment Finance
File Mark
�NSrRUCnorvs: APR 0 6 2009
To be �led in person or by mail wrfh fhe CountyAuditor o/ the county where the property is located. �
Fding Dates: 7) Real Property: Dunng the 12 months be/ae June 17 0/ the year the deduction is to be eRecGve.
2J Mobile Homes assessed under IC 64J-7: 8ehveen January 15 and Maroh 2 0/ Ure year tbe deduc6on is fo�bq�ec6v��
See leverse side for additional insWctions end quali(catioru. Q�/Q a
�/
AppliSan�wner ar contra�t buyer - see �eshic�s on reverse stle) � n � _
�
Arid Key n mber I legal n
' - �-�o- -��G
value of 2al popehy as d March 1, prrenl year Abrtgage /(
cvrtent year
name rn record is different Ihan Nffi of applicant, indipte below:
Name of rtqrigagee or contract seller �� /� ��
� / 7
���-
Address of mort9agee w mnUaG seller (num6er aM sfreef. dty.
Q —J-J -
shee(. dty, sta(e. and ZIP oode)
applicaN own property in arry other
y In Indiana?
❑Yes ❑ No
ction approved in the amount of:
� �_
If yes, whal countyl
20 _
ress unpaid as of March 1, Is Ihe appfipnt Ure sde lepal w equitade o.meY1
� ❑Yes ❑Na
If owned with someone dher than spouse, indicate wilh whom.
COUNTYAUDROR
2b I 20
Is Ihe P�M.i� ^..'__
. :67.
0
0�.�.•9.....
D1•����erN�••... �� —
CATCi ��• ...... .... • • " —
20
requested on property
❑Yes ❑No
20
�riaWre of Countylwdilor \�\� I Counry I Date (nanth, tlaY•Yee�
I I We certiry under Ne penalry oi perjury that the above and toregoing infortnaGOn is We and correct and tha[ the applicanis was / were a resident of
Indiana and owner of Me aforemenboned property on March 1. N)
inaturdlaJne/s hdl namsl .) i ` Date (nJo^Jh• OaY/Y°e�)
state. aM
Person aulhonzetl by duly exewled Power of Attm�ey or by
Adtlress of aulM¢etl person (numbar antl sheef. cily, stete
aM ZIP wde)
`/V �ll���
Date (monfh, day, Yea�