HomeMy WebLinkAboutMortgage_Taylor"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun 7ownship vear
_, ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R71 / 6-W )
�' u» f PresvibeE M ���M W Loql Govemment Fuiamx
INSTRUCflONS: �� � Y
To be filed in person w by mail with (he CountyAUditor or Counry Recorder ot the counry where the property is I u
Filfig Dates: i) Real Pmperty: Musf file dunrg the year (or which Ihe deduclion is sought Counry Auditor
2) Mobde / Manufactured Homes rwt assessed as Real Property: Must file dunng the fwelve (72J months
6efo2 March 37 o/each year Ne deduction is soughL �� � �+nty Recorder
Seereversesidefor�dpdionalinsWCGonsandquali�cafions. _ ,.,e�n.� � O�.v .��..�rne
T Key mmber/�epal desm��— �•���� u Recortl n�mper Page numCel I
O� CJ �l �
Pssessed vahie of real N Abrtgage / Contraa intle6teEness unpaid as ot Mongage / Contract indeMedness unpaid az d Is Ne applirant the sole
Ma� t, asrem yrar Mamh 7, a� /m-� �r date of appGCation . kgal w equttable awner?
V� vli� • ❑ Yes ❑ No
If ro. what ¢ his! her exaf2 share ot inteiest? If mmed with someone other than spouse. Indkste with whom
tl tWrie m remG a tliRerent Nan Na� N aDP�I ��m1e Ce�ovr. �s ihe property in puesaon: MnuaOy Assested
❑ Real ProPertY ❑ ArmuallY Assessed
Name of rtmrtgagee or contrarl5eller 1,���l
1 / I
Pildress of �/'
rtiMgagee or mntrad seAer (num6Pi and strae4 �+ty. stale. arvl !P co
Name of assi9nee or oNer owner a halEer of nprtgage
Adtlress ot asvgnee (num6er aM strcet �; slsta, aM LP code)
Oces epplimm o,m property in any oNer I( yes, what caunt�?
counry in IMiana?
❑ Yes ❑ No
CC
20 _ 20
Si9natwe d Cauity Autlimr
Dra„��i-.o. aoos.......
unstetl m 7�GP+G
❑ No
c���a tiTo. ..��a........... � Y�
20 _ � 20 _ � 20 _
Caunry
�
Date (monfh, daY Y��
20
I/ We certi(y under the penalry of perjury that the above and foregoing informatlon is We and cortect and that Ne applicant is a resident of InCiana antl
owner / contract buyer of the aforementioned propg{ty on date application is filed.
rtunue.fowne nem . � Date (rtmfi, daY. Ma�
^J
s3te,
by IL 61.142-0J
person (wm6rran0 sbeeL ary. sbte.