HomeMy WebLinkAboutMortgage_Chapman""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count 7ownship Year
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; FOR DEDUCTION FROM ASSESSED VALUATION
State Fwm 43709 (R11 / 6-W)
S f Presaibed by Deparimeril of L.oral Govemmenl Fimnce
,� � iie
INSTRUCTIONS:
To 6e filed in rson w b mati with Ne Coun Auditw or Coun Recorde� of the wun where the �
Pe r h N h woae�N �s i� �
Fi/ing Dates: 7) Real Properry: Must file dunng the year (or which !he deductlon is soughf. � Counry AuEiwr
2J Mobile / ManufaUU2d Homes nof assessed as Real Property Must fi1e dunng the 1weNe (72) months
before March 31 0l each year the deduction is sour�ht. p C��cy Recorder
See reverse side 7a additional insLUCtions and quali�icatrons. ^ � �_
AppGc�t(owrmrarcantraubuyer-seeiesnictionsm2veJ;eside) //i n I . -
Ta - isma Key nmDer / legal d�wiption
a 2-� -as- a� -
Assessed ralue dreal prapnty d Mortpage / Contraa'udel
Marrl� 1, �t yex Marrh 1, arrmt year
I
If no. what's his / her exact shara of interest?
If name m mmrE is dMerent Nan Nat o( appficanl, iMicate DeWw:
«oonvau
.s�r.,.��,. �-,.:r!�
Name of assignee w other owner or hdder of nprtga
assgnee (number arM street clry. slefe. a
- � a�_ i_
ant ovm praperty in any olner
Detluction approved in the amount of:
20 � 20
��.
o- 000. 3,'4 -o �� v. Rem,cr,m,weT. ,,�a,noe.
unpaitl as U Mortgage I CortVar2 mdebtedriess unpai0 as d Is Ihe appG�ant Na sde
tlate o( appfcation legal w eQUBade wmeR
� ❑ Yes ❑ No
vhM somear�e dher ihan Wa�, indimte wiN wMrn
Dra���cr \TO...°.��.�.a �
c���d ��o.�.�..:::a3...: �.�.�:.:
� y �, � 9�i a� : � . : ,
20 � 20 � 20
Is tM P�7�nY m Ouestion: MruWty Assessed
�Real ProPenY ❑ M�ualN As��ed
las Uis deduUian Geen mquesteG m praperty
x curtent yeaR
❑ Yes ❑ No
20 I 20
Sigta/ture W Counb Auditor I Counry I Dale (manth, daY� Yea�
i '" T � wTV+,�.t.t//
�/ We certi(y uMer Ne penaly o( rjury that the ve and (oregoing infomialion is W e and correc[ and Mat Ne applitant is a resident of Ircfiana and
awner I mntract buyer of ihe aforementioned p rty on date applicaUOn is filed.
SignaWre (ownefs ra Date (rnmM. day.Year)
I �d � � ��a� � ,,,� ��
FWIr'dsidmtaEtlrassdappfrant( � berantlsbeet.ory.sfale,arMnZlPOOtle \
V Q� � 't�0 � � 7� 7�
.,t4"l�_Par�d-f.ers �o rivi« �.
Person auNa¢ed Ey EWy ezecuteE Porer W AtlnneY a q' IC G1.1-1 -0.7 � Date (monN, Cay. yea�
Adtlress of aWmmetl person (num0er antl street ary. s+ate.