HomeMy WebLinkAboutMortgage_Holmes'°* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS un wns ip Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
.�a �,,, ��� cR„ ��> D C 3 0 2009
S f Prestri0ed OY �eP�ent of Loml Govemrtrent Frence
File M
INSTRUCTIONS:
TO be filed in person w by mail with Ihe CountyAuditor or Counry Recorder of the county whele the pioperty is located. � �
Fili Dates: 1� Real PmpeAy: Mast file dunrq the }rear for which the deduc6on is sough[ �Y AUD170R
"9 pIBSON C CounryAUdimr
2) Mobile / Manufactured Homes iwt assessed as Real Property Mus! fi7e dunng the nvelve (72) mon�ths
6e/ora March 37 0/ each year the deducfion is sought ❑ Cou�tY Recordv
See reverse side (or addilional inShucUons and quali�cafions.
Ma�ram (ox+ierorcontra uye�-see rashi�ons on raversa side) Q 1 / //
rr.'� �i.. 9� %i'1 „ .. . . _ I KY n-Y /iil
i vi i - -
Assessed raNe of mal paperty as of Mortgage/ Cont
MazM 1. amnt Yrar Mamh 7 a N
� i��
If I10. Wh3I6 h15 / hC! CidC Sh218 Of 41�ERSl?
If nama on reco�d is dAferen[ Nan Ihat ot app�nt, Indinte bekw.
Nartre at mortgagee p oontrarl seller , _
PDtlres of rtnr[gagee ot contrad se0er (
Name M ass'�ee or oU� owner or hdd
Address ot assignae (number aM sheet
Ooes ePplitant ovm property in any oNer
caunryinlnd'vna? ❑ Ye5
Deduction approved In Ne amount of:
20 20 _
Signanne U Caunty nuditor
num0er aM sveeG �+N state, ,
er d mortgage
cGy, sbte. anALPootle)
If yPS. what �rn
❑ No
�
az of
� .7
aare
as d'Is N�
�
Yes ❑ No
If ovrtred wrth mmeorie other ihan spouse. i`diote with whom
Is iM property in Question: Mnua�y Pssesse0
❑ Real Property Q MnuallyPsse55ed
mRa•/ �,�'d -
Cc�saY � .
Di- C� � �3 � �
20 � 2b � 20 _
reduested m PmpenY
❑ Yes ❑ No
Da�e (mw�fh, d3Y. Yea�
20
I I We cerOfy under �he penalty of perjury that Ne above aM (oregoing infortnation is We and cortecY and that the appliran[ is a resident of IrWiana arxl
owner / mntract buyer of the aforementloned property on date appliption is filed. �
uature towrah NO remel _ Dale (mvh� daY. Y��)
full
Pbson
arM sheet
61.1-12-0.7
person (number arM sLeet �+�Y. sta(e. aM LP cotla)
��
Qate (nionN.