HomeMy WebLinkAboutMortgage_Williams (4)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ICoun T ip I r
__ FOR DEDUCTION FROM ASSESSED VALUATION
, State Fwm 43709 (R71 / 6-09)
� � Presaibetl M DePartmerd a1 Laal Goremment Fnance
�� File Mark
INSTRUCTIONS:
To be filed in person or by mail wiN the CowtyAuditor or County Recorder o/ the counry where tAe pmperty is located. F� �
Fifing Dates: i) Real Property: Must file durirrg the year for whirh the deduction is sought. � j�J �y un��y� d"
2) MobAe /Manulac2red Homes not assessed as Real Prtipeerty.� Musf fi7e dunng the fwelve (12) monfhs G BSQi� COUNTY UDITOR
6etae Ma2h 37 of each year the deduction is sought. LI County Recorder
See reverse side (or addit"anal instrtutions arM qualifications.
Amfranl lawrer � m�traC burer - see rashi�wa m reverse vdel
�/ Key rcmCer / legal Oesaip�im Remrd numErl Pa9e numGu
�.�� a� -ia-o3-vo�-oo�{3 a�-oa � � �� 8 0
0.seseO rahc d mal prapaty as o7 Abr(qage / Contrau iMebtetlness unpaid as W Mortgage I Contracl mdebtednnss �mpeid a d Is Me eppOmnt Ne sde
� 1. ar�+rt i� MarM 1. airtrnt year Eate ot app�Catian legal or eWltade ownef?
L 9 �C7O ❑Yes ❑No
rc m. wha� 5 nis � tre. eraa sha.e or interesn rc ownm witt, sa„eone ot� a�an spaae. uwxata wim whom
II name on remN's GftMent tlan Nat o1 aPP�t'oidkate belmv. I5 the m puestion: M��e9Y AssesseE
Real PrupeAy ❑ Amually Assessed
. Moble Hpne (IC 61.L1
Name ot mort9a9ee a contract sever
mor[gagee or oontraa se�er
oUml wmer w halder M morigage
PDOress of
ooes aQpinm wm p�opem�
oounry m Ind'ena? r
�
or
ctiy, state, ard LP coda)
tity; stafi. entl LP mde)
3_a-io
�— I �
I I We certity unCer the penatry of �Erjury that
owner % mntrad buyer oi the afaeme�rtirned
maWre(owne�fi�reme). . •
�; stafe. and
by tlW1' exewted Pw�er of Attm�ey
Address of auCromr� person (num0er antl sbee{ ay, sfate,
/ • 9 9 f� �- -
VJhat Tapng D'svuY7 Has N's detlu�4m Oem re0uesteA m propaty
��a� ❑ YPS ❑ I
COUNTYAUDRO . _
Dra�}�er 10..�Q.��.........
—
20— C3I'd �i�. .... V J�........
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nd foregoing mfortnalion is we and cortect a`w � w� ��� on...�... __ ana ard
date appilcation is filed.
Date (rt�onM. daY. Y'��
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