HomeMy WebLinkAboutMortgage_Williams (12)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C ; owns ' ar
_ FOR DEDUCTION FROM ASSESSED VALUATION ,
Stafe Form d3109 (R10 /N-08)
S f Presttibed bY �Mien� d Loral CnvernmerM Finar�
INSTRUCTIONS: Ie6.�tan�Z009
To 6e fileC in person or by med wifh the CountyAudifar d the county wfrere tAe property is locefed.
Filirg Dates: 1) Reel PropeAy: Must fi!e dunng fhe yoer /or which the deduction is sought. `�j
2J Mob�e / Marndacturatl Homes not essessed as Real Pioperty: Must file dunrg tlie tweNe (f 2J mmths be/ab'L1S� 3�� year
Netletluctionissought. GIBSON Cl
See reverse side fo� add�tional instrvcfans and qualificetians
COUNTY AUDITOF
Appfimnt ownalmmik�aclMA'a'see revrrsoside
,n,,Y„�a- ,P �-� �'°�°'� M.✓„ � /mI;DO;,,,y.,,,
amaN yaa
@ ro. what q h"¢ / hn axatl shxre d irtle�esY!
reme on iemd is
i - g- -ao/.a�o-m
Aartgage / Lonlratl odebteMasy unpaid as N Matgage I Catlrar� inAedednes
Aarch i. anaN year Oate o( appfimtion -
/0 OD Q
I( avmed with someorre oiher Ihan spousa.
indimb hebw: ' ' —
� . � /,. .
Nama d assigrree or other owner a holdm d mutpape
ACdrass d essignee (num6ar antl �. l=Y• sbta, arW LP mdo)
property in arry
Ueduction aOD�oved in the amouM d:
yes. W�al wuNy7 I Whal Taru
COUNTY AUDITOR
ZO � 20 � 20 � 20 � 20
unpaiE as af
a 0�� -
�OOy
� � �—cJ� �C� Li1,
20
20
sala
ivrieR
� No
I 1 We certify uMer the penairy of perjury U�a[ the above and foregdng information is W e and owrect and that Ue apd��nt is a resdent of India� and
awner / mntrad buyer of ihe afomfnentioned poperty on date application is filed.
md LP wde)
ar by IC 6-1 J-12-0]
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Dale (rtmM, day, year)