HomeMy WebLinkAboutMortgage_Claybrooks� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_, , FOR DEDUCTION FROM ASSESSED VALUATION
State form 93709 (R71 / 6-09)
�' w. � PresmbeO by DePartme(H of Local Govemrtrerrt Frence
Fil
INSTRUCTIONS: wrth,
To be filed in person a by mail wiN the CounryAuditof or Counry Recwder of Ne counry where the property is located. F� q�o [����
Fil'mg Dates: 1) Real Property: Must file dunng the year /or which the deduction is soughc V� Counry Aud"rtnr
2) Mo6de /Manufactured Nomes not essessed as Real Property Must file dunng the fweHe (12) rtanths ❑
6efore March 37 of each year the deduclion is sought. �R��
See reverse side for add'NOnal insfructvns arM quali�c�tions. � nR
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IMW�3W(eM�roreontradb++Wrisee m� ' e) • � /1 � A .._,..�w� COU —�
I 1, cvrerrt year
If m. what fs Itis / her e�md share of interastl
az
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as d I b Ne eP�t ihe soE
legal a equitatle owne!?
❑ Yes ❑ Nu
If wmed with someorre other than sDa+�. IMicate with vAwm
If rwne m remtl e Wftermt Nan that W app�carLL, tr�tlinte 6elmr.
Name o( mM9a9ea w mntract se0er
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owner a holdu M mort9a9e
ffire,
Addres W aivyree (numDer end sDee4 �Y. sfaM. and LP cotle)
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munry in IMana? � _ _
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Is Me V�PertY in Vuestion: Mnue�y Asscsud
❑ Real ProPertY ❑ M!u!a�ly A�essed
M25I�16 dl'DUCbY1 �fCl1IC�UGSiGd 011 pfOPCIY
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for curtent Y�R ❑ Yes ❑ I
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I/ We cerdfy under the penalry,,. ye� Ne above aM foregoing infortnalion is We and cortect arM that Ne applicanl is a residertt of IrMiana aM
owne I mntract buyer of property on date applicatlon is filed.
i ( Date fmmfi. EeY. Y��
W t(number and stree4 dfy, 9ate. 2M LP ootle)
2 i 90 s 50 �,l F/av�s;� a,— rn/ y�6.39
auNOmetl Ey duty �ewted Power W AtmmeY a�' IC G7.1-12-0.7 - Date (rtmN. OaY. Ye�
tlress ot authoraed prr.,an (numDer aiM sbee; dry, stata. enC ZIP mde) . �- ''-