HomeMy WebLinkAboutMortgage_Jay"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
, FOR DEDUCTION FROM ASSESSED VALUATION
Spfe Farm 43709IR71 / 8-09) �
,' ar PmsmbeE M�rtmek of Lxal Govemmeirt Fumnce
File Ma�k
wsrRUCnoNS:
Form filed wIM:
To be filed in person or by mail wifh fhe CountyAUdifw w Counry Recorder o1 the counry wliem the poperty is bcated.
FAing Dates: 7) Rea/ Property: Must fife dumg fhe year fof which the deductbn is soughc � Counry Auditor
2) Mobde / ManufacYured Homes not essessed as Real Property: Mus! fila during Me hveNe (12) months ❑
6efore Mamli 37 oleach year fhe deducliun 's sayht Cou^r1 Recordu
See reversa side lor additional inshuctbns and qual'dreations.
( or mntraa 6Nt� msfictions m reverse side)
� � G c.J
Tad Key �wmCer / legal Ensai Remrt1 numbar Page numbu
� o� ab- �q-�-3� -�m�.3d'S—ov � 8
Asxaed vahia d mal as ol Mp�qyge / ConbaC 4drbtetl�ress unpeid as d e/ Cantraa'uMe6teMes. imC� as R A tlie eOP�� ihe sok
Mart31 1. aIRN Y� �Y Mam}� 1 rtent Y� C�te of aDP�� �� °f �� °�^�
a OT� ❑ Yes ❑ No
�r ro, what 6 nis � nrJ eraa share of infcesrr rc ow,m witl, �x mm. man saa+se. u,a�iu�e rm, wrom
If nartre m iemtl o dRerent fhan tlia� ot aGV�L "uMicate bebw: Is ihe P�PeRY in Cuestian: MnuaDY Assessetl
nRealP�ertY ❑lvmualNAsse�ed
m mntrarl
or canVaU seder (nuMe� and sbeeG �Y. stete. aM LP coda)
Name o1 a�gnee a aNrl owner a holder of rtvtgage
ACCresa af atignm (numbar and 4�Y. �e. antl LP co0e) v'lpra., �
�T cv 3�.3- ro / fF� ais �r
o«a spp�m o«� wovenr ��r am« ir yes. �az ca�+Yr wnsi rarire osmaa rws me em„�xm ypp�
munry in In�mna? (, Yrs ❑ No lar anerv YPaR � Yes ❑ No