HomeMy WebLinkAboutMortgage_Harrison^'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_, ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (R77 / 6-09)
�' w� � Presaibed q' DeParVnettl of Lod Gwemmerit Firenta
INS7RUCTIONS:
To be filed in person a by mail with tha CounryAuditw or Counry Recorder oJ the county where the property is bcated.
Filing Dates: 7J Real Pmperty: Must file dunig fhe }rear for which the deducUon is sought.
2) Mo6de / Manufaduied Homes nof assessed as Real Property Must file dunng tha 1weNe (12) months I
6efore March 37 of each year the deduclion is swyht.
See reverse side (or addifional instrvct+ons and quali�rcatpns.
MMuam(mmeiwcanvaubuyer-seam on(everseside) � `
��y,� GIBSON
File
� ��IyAUditor
❑ Counry Recorder
Oistrict , Key nimber! legal desai Rem(d numou Page numar n
_ _ _3Do-oo . o -oo-� Oq 99 �
Msessetl rdWe d real ycper:y as ol Mwtgage / Contract inCebtedness unpaid a W Mortgage I CanSacl cWe6tedne55 unpaid as d Is Ne eppGont fhe sde
Mard1 1, arrem ytlr Merth 1, artent year date o( appGption le9al p eQUitaCle ovmeYl
�D( OC7 ❑Yes ❑No
I Ir ra. what fs h'¢ I her ezaa share or interestt Ir owned with someone other than sDa+se. ind'xate wim wiwm
m
�!!'..^^.e
Name of mxtgagee or contrarl se�er n' L/� _
� '
Pddress d fmtga9ee w contrad se0er (nvnbu and sbee tdy. sate, aM LP m
Name at asvgncre w aNe1 owner w twlder M mortga9e
AdC2s5 Ot a55igtree (nUmbr! eM snee{ ttiy, stat¢, eM LIP mtle)
Dces aPyifant o.m poperty in any other I( yes. what munq?
munry in IMana7
❑ Yes ❑ No
Detluction app�wed in Ne artwunt ot
20 � 2p _ � 20 � 20
Is C�e property in QuesCOn: MmlaDy Asusse0
❑ Rea� aroveM � A^^�N�
Modle F'brt�e QC fr1.1-i
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Dra�ver r �—
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�rature of Counb Autlitcr Couny Date (rtanth. tlaY. Y��
I/ We certify under e penalry ot perjury at Ne above and foregoing infortnation is We and cortect ard that the applicanl is a resident of IrWiana and
owner I contrad b er of the aforeme � ed property on date appiication is filed.
araNre o h hAl name) Date (monN. daY. Y��
� — N `_
FW revGent add�es of ap rcant (numDer artd shee4 ri�: s��e. a�d Z�P ar
ZSO So..+h ��SO E�sk
Pe�son auCio�rzed Gy duty esecvted Povrer o( AttameY a M IC 61.1-12-0.7
ACdress ot aWqf'ved persori (number aM sbeef. dry, s!a(e. ard LP oode)