HomeMy WebLinkAboutMortgage_Willis (4)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T ip
__. : FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R71 / 6-09)
\ 1 PrestriEeO by DepaRmerrt of Local GovemmeM Frerce
�w
F'
�srRUCnoNS:
fo 6e filed in Fortn fled with:
person or by mail with the CountyAuditor or Counry RecoNe� o/ the oounry where the property is located.
Fifing Dates: 7J Real Property: Must file durirg the yrear /o� whicli fhe deduction is wught. ��� ��� �
2) Mo6i7e / Manufactured Homes rrot assessed as Real Property: Must fiie dunng the tweNe (12J months
6efore March 31 of each year the deduclion is sought County er
G SO COUN
See reverse side (or addifional insVUUiw�s and qualifications. ,�
�
_
' - _ 0 / -l100 . /- 06
y a d Abrtgage / Contraa iMebtedness unpaid as d Mortgage / G
Mamh 1, airtent year date af eppGc
h21B Oi IIIWlESi? Ii O'MICd'N11f150f11COf1E
Nan ihat ot appficant'oMira[e Gebw.
Name of rtnrtgagee or mntraU seAer
Address of matgagce w cantract
Name af assip�ee
street cay. state.
s1ree4 �Y. �te. and Z/P
di�nt ovm p�oprJty fn eny oUer I It yes.
Intliara?
❑ Yes ❑ No
DeducO� applwed'o� ihe amoun
� �
Sigrature W CA�mb Autlitw
COUNTY AUDROR
number
mtl¢btetlness MV� az of IS MC aPPrxani tt10 SOIe
legal w eQuilade owne/?
❑ Yes ❑ No
spouse. iMlcate with �N�wn
p�ope`iy in 9uesUm: Mnually Assesud
ea� arovenv ❑ /+��N �
AW We Fiane (IC 6
� a�l� ..
p l• a�� er N O . . . . . . . . . . . . . . . .
_� � v,.....
= c�,-a�ply�� �`� I
20 _ � 20 _ � 20 _
Daie (�rovh.
zo
I I We certify under the peRalty of perjury that Ne above and foregoing infortnalion is W e and cortea and that Ne applitant is a resident of IMiana ard
owner / contraU buyer o e aforementioned property on date appliptbn is filed.
�ry�p Date (rtmfi. daY. N�a�
' � i
� p,� n/um nd sheet sfate and ZIP ) /n'l
l� �i�Y%/
Pelson auUroraed Dy duty ezecuteE Pouer of AttomeY a IC Sl.t-12-0. Date (rtimlh. tlaY. Y��
Mtlress of au1Mi'ss.ed Verson (number aed smfet cM state. and LP code) .