HomeMy WebLinkAboutMortgage_Collins"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �
iY •.
S ' �a�,,,����R,,,�> a �
,.,� Presaibed by Departmem al Lnml Govemmem FUanca
ya..�+�
ie a
STRUCTIONS:
To be filed in person or by mail wiM Ne CountyAud'ROr or Counry Recorder o/ the county wFiere fhe poperty is located. M�
Filing Dates: 1) Real Propedy: Must!!e dunng the yearfor which the deduclion is sought.
2) Mobile / Manufactured Homes not assessed as Real Propelly Must file dunng the fweNe (72) months C.
6efore March 37 0/ each year the deduction is sought.
See reverse side (or atldifional instructions and qualfications.
Appbram (ownerarcantrpd buyar,-3ee reshictiora m rse side)
Recorder
Tati Distr'r1 Key rnunber / legal desaipdon � Retvd nu Page numbrl�
a� � ��-�3 - o -oao. Pot - oo � 1 a� I 3S
Aaessed vahie cf real p�operty az d Mor[9a9e / Cantraa indebteE�s un0aitl as of Mort�a9e I Conraa'a�debiedness un7� as d Is the aPP�� ihe sde
Mardi 1. anan year Marrh 1. airterit ynar� date of aPP�'atan legal or epuitaWe wmnf!
3 �QQ � ❑ Yes ❑ No
�� fq. W�1315 �16 � hEf C%dLI5il3f9 Oi IIIIPIPSI� i QMIBd Wlal SOf11EOf1E OIt12! I�12I1 52. IfldlfdSB WII�1 W�IOffl
If name on remrE is drtterent ihan Uai ot applifant. ifMinte bebw:
Name of rtrortgagee ar mntraa seller �/ .�
Atldress W rtwrtgagee w mntraG s�er (num0e� antl
Name of assignee w oNU owner or holder of matgz
Pddress of atsgnee (number aM street �y, slate,
Qr E N w
Does applirant own property in any olher
tounryinlndana? ❑ YCS ❑ No
DafuUirn apprtrved in fhe amount of:
20 2U . 20
1/ we cerofy under the penatty of periury M�Y
owner I mntraa buyer of Ihe afaementioned
7�wrP{pw�eYsfiiOnama) n � ^ ,�
Person autlm�¢etl OyGUty ezeated
\' ' — 1� _
D����,���� �.�o.. a�l a,..
............
�����.�o.... ��35
�� 3�, 315, oi� �.....
above
�pertY a
state, ai
20 I 20
Is Iha Property in Question: MnuaM Assessed
� Rea� aiovenv � nm,ua�y wssessee
Has iTis deduUion been reVuested m property
fw arten� Y�n r-i r-�
20 � 20
(oregoing intwmation is true and correct and that Ne applicant is a residertt of IrWiara aM
e apP���� is fiietl.
Date (nmN. daY• 5'aah
or by IC G�.1-72-0J
person (num0er aM saee; tdy, slate,
Date (month, daY. Y��