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HomeMy WebLinkAboutMortgage_Morris"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear __ FOR DEDUCTION FROM ASSESSED VALUATION Stata Fortn 43709 (R11 / 6-09) ,' ur Presaibed M�rd o/ LoW GovamrtieM Finatm F INSTRUCTIONS: " To be filed in Fam Aed wiN: person or by mail with the CountyAUditw or Counry Recorder of the counry where the property is located. )� ' n Filing Dates: 1 J Real Property: Mus[ file dunrnJ fhe yeer for which the deduction is wught. AU � 9 r,qullt�A�7dimr 2) Mobde /ManufaUuled Homes not assessed as Real Property Must hie dunng the fwehre (12) imriths befwe March 37 of each year the deduclion is mught. ❑ Cou^tY Remrdu See reverse sde for addifional insfi�ctbns arW quali�caGons. N �� ^P °' r-� fe"�B • Q ti�BgdN d6 NfiV A.CITOfl �n q���, �� n� „ n� n,�, �-' �- D - /- Uv � �D/. a' -ooz. 0?0 0 of ' � A�srssed raWe d rnal pvperty as W Mwp�a ge / Contraa IrdehteEeress unP� as af Mortgage / Cmtrac'vWebtedrress �m7� as d b Ne eOPOram Ne sob Marth t, nnvC ym Memh 7, artr�rt yw tlate of eppGcation legal or eQuitable avrrYi ❑ Yes ❑ No rc no, �c �s nrs � ne� eaaa snas or ��srt n o�,aa �m �� oa� ma� s�. ma�e wim � If name m remrE's EiRerent Man Cut of appAcan4 �7�� belovr Real PIDPeKY ❑ Armua�Y A�sed a�ma� rw� nc ��. r+ama oi morteayea « ACtlress d mortgagee ar mntract se0er (nurtNer andsfrB�C d1Y, sbm. aM LP code) �/ S Name of assi9nee or oNU owner w halder of mart9aBe " �„ n�/ ^„� OD��� uK � `�; ACAress ot asse,piee (number entl srteet dry, sfete, aM LP oode) � Does eppircam own property in any other It yes. what county7 NTaf Ta�dng I �'1 //� i��8 / cwiuy m Ime�u? ❑ Yes U(/ ❑ No COUNTYAUDROR Deducfim aowoveE In Cn amount of: 20 _ I 20 = I 20 - I 2a - I 20 I 20 I n1 Counry Y�� � I I We certlfy urWer the penalry of perjury that the aDOVe arW foregoing infortnalion is true and cortect arM U�at the appli�ant is a resident of IrWiana aM owner I contract buyer M Ne a(oreme�oned property on date application is filed. � sq r� ae � �� `�'o2U/ ° .[ Full resjQ �addtess ppfrcan (number a Slree4 �}: sfate. ZIP mQr.q��� /� , l�� �D /� O� V GCliT � . . � Pcem autlnrzeO Dy d�dy mcewte0 Po� of AIIOrroY IC F7.1-12-0.7 Date (ma�th. deY. Y�� '_ Deeson (nnmbrraM streeL �Y. state. an0 LP mde) _` �- �_