HomeMy WebLinkAboutMortgage_Williamson (2)N� STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS
:.�_.
= FOR DEDUCTION FROM ASSESSED VALUATION
• Slate Fortn 43709IR77 / fi09)
�' ,,,, f Prnsm6ed by DepartmeM of Locai Govemment Frence
Coun Township Year
INSTRUCTIONS:
To be filed in person w 6y mail with !he CounryAUditor or Counry Remrder of the county where the property is located.
Filirg Dafes: 1) Real Pmperty: Must file during fhe year for which the deduction is sought.
2) Mo6ile / Manufactured Homes not assessed as Real Property: Must file dunng fhe fweNe (72J months
before March 37 of each yea� the deduction is sought.
See reverse side tor additional insWctions and qualifications.
# real P�P�Y az of
year
11 m, what ¢ his I her exatl share o( interest?
� - � � ..
��„� 8 aQ�
Auditor
❑ County Recorder
'/ legal desviption Record number Page numbef
-a3 -�� -�oo - oo-�. �Y7 - o �`t a-oo 03
U��y ge ! Cantraa'udebtedness unpaid as o( Mori9aqe / ConVaU'vdebtedrrtss unpaid as of Is Ne appGmnt Ihe sole
Mard� 7. airtent year data of appfifation legal w cquitaWe mvneR
3 yoo ❑Y� ❑No
' If awned wiN someo� dher ihan spouse, iMirete wBh wlwm
It nama on �ecard is dAterent Nan ttut of appArant, mAibte belmr.
Nartre of rtqrtqagee or cpntrarl elle(�� �
7 Gu
Addres af rtiartgagee or contrad se0er (numher rM stree; crty, sta[e, aM ZIP code)
owner or hdder of morigaga
(num0er aM streeG �y. sfafe, end ZIP co0e)
Does ePp6rant am property in any oNer I If
county m Intlana?
❑ Yes ❑ No
Is the WoPenY in Ouesaon: MnuaOY As:.rssed
[�Re21 RoPenY ❑ �;?�Y_�
D���,ti��,�.�o.... aCO`�.
Card 1\`O. . y �. �,�j.
......... -
�3q, yoo . u� o
COUNTYAUDROR
Deduction approved in Ihe amount of.
20 20 _ 20 _ 20 20 ' 20 _ 20
Sig�ture N CoumY Audimr //s�� y Counry Date (month, daY• Y��)
/✓ /
I/ We certi(y er Ne Oenalry of ury that Ne above and foregoing in(ortnalion is We and cortect aM Ihat the appG�ant is a resident of I�iana arM
owner I contract buyer of ihe aforeme�rtioned property on date applicalion is filed.
SignaWre (owne/s hN �me) Date (month, eaY. Y��
Z �
Full resident addtess of appfinnt (number and sheef, c'rry, state, eM ZIP oode)
12Z01 G Ma�.hS'-lacl ( �, �i76.ir'J
Person auUq'rzed 7y duy exewteC Poxer of Atforney rn by IC F1.1-12-0.7 Date (monfh. daY. Y��
Pdtlress of auNOraed prJSOn (numbe� arb s�ee4 cM. sbfe. antl LP cUde) _