HomeMy WebLinkAboutMortgage_Weeks"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u� T hi � Year
$_„ FOR DEDUCTION FROM ASSESSED VALUATION _, %
Sfata Fam 43709 (R71 / 6-09)
`,,,. Presm'CeE q' Departrt�erH af Local Gwemmeiri Fiturce �
Fbe RR�f1f�
INSTRUCTIONS: - F� A� �:
To 6e fied in person or by mail with the CounryAuditw or Counry RecoNer o! the county where the p�operty is locat�)-r� �,���,!��
Fitirg Dates: 1 J Real Property: Must file dunng fhe year fw which the deductbn is sought. a' • 7�1��:ounty Fwditnr
2) Mobde /Manulactured Homes not assessed as Real Property Must file during Me hveNe (72��t� CO NT�]p�J
6efae March 37 o{each year Me deducaon is saght �R�w
See 2versa side !or additional instnmJions aM 4�lifications. _
Assessed vahx a(� O�O�Y U
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rc �o. w,ac t� n� � n� �a sn�re
If rwne m 2md'o tliffemnt fhan
Name at rtnrtgsgee «mntract
Mdress af rtiortqagx a mntra
oroNerownerw
AdClB55 Of d5119f18B (lWlMCI d110 5!
Does a�titant avn D�VertY in any i
muHy m Ineana? ❑ Yes
amount af
ry rwmber / legal desaiptan
/
ortga9e / Contrau IrdeMetlr�s unpaid as W hL
�,,.��dd� �
�p H owned wil
app�canl, 4Mirafi belmr.
r '
nu b� e� 4�Y. sbm, aM LP cade)
ier d mortgage
rny, smta. aM Z/P cotlel .
r If yrs. what muntyt �at Tarir.
❑ No
/ � M/ A�, COUNTY AUDROR
unpaid as of
swneore ather Cron spausa. u�drate with x7wm
Is Ihe P�PPrtY in Ouestion: Mnw
�Real Pmperty Q Armual
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Sig�Wre NCmmb AWitor Counry Dete (rraNh, daY•Y��
� I I We certify undrl Ne penatty oi perjury Mat the above and foregoing infortnalion is We and correG and that Me appiinnt is a resident of IrWiana arM
owner I contract buyer of Ne aforemerrtbned property an date ap�iration is filed.
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