HomeMy WebLinkAboutMortgage_Weiss (5)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
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: FOR DEDUCTION FROM ASSESSED VALUATION
� State Farm d3709 (R71 / 609)
�' � Prewibed M �ePM�M of Laal Governmem Firence '
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ie a
wsrRUCnoNS: �AN �
k be lled in person w by mail wiN Ne County Auditor or County Recorder o! fhe county where the pioperty is locat .
Filing Dates: 7) Real Property: Must !le dunng the year (or which the deduction is soughG �unty Auditnr
2) Mobile / Manufactured Homes rwt assessed as Real Property: Mus1 fi/e dunng the fwelve (12) mon
6efore March 37 07 each year the deduction is sought. � Cwinty Recorder
Seereversesidefor tldiona instrtxliwuandqualifica�s. � � �;�RGnN COLINTY Au�ITnR
MP��� (ownerar lrarl buye �° r�C4ct� .°^ �°^�e n. „/1
0.se5seC rahn d mal O�P�Y as of
Marh 1, amnt y�r
If ro, what R his I her euG share
If name an remd
mortgagee or mntracc seller
r I legal desrnption Record number Page number
-� �36-Ya3-c�.o
ge/ Contraa inde6tedness unpaid az of Mwigage I Con�aU inEebteC�xss unpaid as of h Ihe appGfanl Me sde
5a�1
Ma 1, Q Eate of appGcstion legal or eW i1aWe ame(?
IS(J.S ❑Yes ❑No
If owned wiN someorie other Ihan spouse, ifWuate with whom
. uWitlte Eebw Is Ihe P�OertY in QueStian: Mmia�YPS5e55e0
❑ Real RoPeKY ❑ �TM!��Y � . . _
mno-aa ssrLJer (numbrl aro sneet
Name
�d� Dra�ver NO....(.�..�� �
ooes
�� Card NO. ..........�........
�, - '� `�� �
20 � 20 - � 20
code)
Whaf Tadrg Districl?
:OUNTVAUDROR
20 20
s Nis deduction Eeen
w�rent yea/!
20
� P�Y
❑ No
20
I�� / 1 1 A/( ,� /W ��� I Counry I Date (monM, dayye�� / o� L
Ul
I I We certi(y er Ihe pe ry of perjury that above arW (oregoing infortnalion is We and mrtect and thal Ne applicant is a resident of IrWiana arM
owner / mntraa buyer oi aforemeMioned roperty on date appliration is filed.
uuwrafaxneh /iAlmrtrel . / Date (rtmfh, deY. Y��
andshee4
V � .
142-0]
auNa'ved persm (numberantl sbee; dry, stafe. enO
Date