HomeMy WebLinkAboutMortgage_Nichols^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
`r_' .
, FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fartn 43709 (R71 / 6-09)
,,.,. f Presaibetl by OeOaRmern ot Laral GovemmeM Frerce
File Mark
�STRUCTIONS:
To 6e filed in person pr 6y mail wiM Ure County Auditw or Counry Recader of the counry wheie the property is bcated. � d
Fi7irg Dates: 7) Real Propeiry: Must file during the year /or which the deduction is wughc � C�unry Audiwr
2) Mobde / Manufactured Homes not essessed as Real Property: Mus! h7e dunng the nvefve (72) monMs C��°�x-�-a
6etore March 37 of eacA year the deduction is sought. Coij �'\ er
See reverse side lur additional instructions antl qualifications. G IBS ON COU NTY AU DITO R
V ��wnerm oonfrarf b er. see resUi e/ L/ ��r/ 7 /�( "Y l J/S
tf�%i]Ll . ) °�
ap�es�ea ,.�we or rea� �ny � m
i(�vi 1. ansa year
It ro, what Is his / Irer exaC share of interest?
If name on r¢cad is diiferent �han U�at ot appl
Name of rtnrtgagee or cono-aa se0er
- �- -.3�a - O/. � 'O _
IMortgape / Contract inde6tednnss unpaid az U Mortgage I
MarM t. artent year Cate o( �p
Address of rtnrtgagce w mntrad se�er (nurtiber and snreR �1y. smte. arN ZIP code)
If owned wiN
Name of assig�ee or other owner or hdAer of rtprtga9e /�
� �
Afldress o` _�."_'"'_"" "'_"_""'"_"'_". ,.,.__._. /
` �
Does appti . 1 Nrtat Tapr
munry in I / • /
�.Ir� �o�s, T�Io�AS �.�
� Q��OR/1 � " � NTYAUDROR
D�LUCtion
20_ ��� /J'��1/�V 0 /✓"NF
r/"I"
Signadne
�,We ��2-9�
rnmer
� FullretiEe
��Q�
PEtlress of authoraeE person (number arN street, dry, stafe, and Z/P oode)
Caunry
kgal «epuitade ow(cer!
❑ Yes ❑ No
ihan spouse, indiota wBh whom
stion: Mnuaaj AssesseE
❑ Armually Psse55ed
I ro. aerenc yean. ❑ Yes
❑ No
20 20 20
Dete (rtnnfh. CaY• Y��)
nfortnation is We and mrrecc and Nat ihe appliran[ is a resident o( IrWiana and
on is filed.
Date (rtmfh. Cay, YEa�
Date (month, day, Yaa�