HomeMy WebLinkAboutMortgage_Tooley (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
State Fam 43709 (R70lU-08j
` � PresuibeC bY �Partrnen� d Lo� GovammeM Firenm �
INSTRUCTIONS: Fle �
To be fited in person a by maH with the CauNyAWifor d the counry where the property is fxated. 1
FilimJ Dates: 7J Reel Property: Must Poe dunrq the year /or which the deduclion is sought. J UN 1 Z��p
2) MobDe / Manulactured Homes rrot assessed es Real Pioperty: Must fde Ourirg the tweNe (12J montlu 6e(ae Mart,� 31 0/ eacA year
the detluction is saught �r
See revarse sitle lar addAional insfrudions arW qualificaGOns .. �e,s ��
Assessetl vAue cf �aal praperty es W
A4N� 1. amartl yaa
M ro, what's his / hm erad share d i�res7T
Name d mortgagaa or mntrad se0er
Pddrass d mo'tgagea v mntad seAer (nunM�and shent �l: stale. antl
NaznB
Does aPp6mnt am prapeM1y in arry Gher
couMy m IM'mre?
❑ Yes O No
amoum
L�i�=�i�i'3!7
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3iaasd �
tl av/ned
Dra���c►• NO..vZQQ�........
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Card NO. .....rJ. q��.
�iio,r�-Op.°°j '�'fl°�,"�.
20 20 20
as
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IRNI SV��. IfW�IfdIB WIUI W:1Nf1
Yes ❑ No
Is me pcPeM � aueation: tvmiaM Assessed
,� Real Property Q MnualyASSesse7
����R ❑ Yes ❑ No
20 20
I/ We certify untler t�e penalty at pxjury Ma� Ne above anC foregoing uifortnatim is true and carred and tha[ �he a�cant is a res0ent of India� aM
owner / mntraci Wyer oF Ne aforementbnetl property on date appliration is filed.
Y���PI (°M'�Srs f� ^ame� Date (mvRh. daY.1'�)
Pe�SOn
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by IC 64.742-0J
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