HomeMy WebLinkAboutMortgage_Williams (2)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co �/ ship vear �
__ � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 63709 (R71 / 6-09)
,,.,. PresaibeE by �epartmeM ot Loral Gavemmenl Flnance
File Mark
INSTRUCTIONS:
Fortn NeL wiih:
To be filed in persnn w by mail wiN the CountyAuditnr o� Counry RecoNer o! Ne counry where the pmperty is located. �
Filing Dates: 1) Real Property: Must file durirg Ne year fo� which the detluction is sought. County Auditor
2) Mo6de / Manulaaured Homes rwt assessed as Real Prope/ty: Must file dunng the hvelve (72) months
betore MaicA 37 0! each year the deduction is sw.� 'ht. ❑ Counry Recorder
See reverse side for adtlilional inshuctiuns arM qualification?.
�
rc no. what is his
If narne on remtl
- .�— OU � U
A1oROape / Contratt'viEeMr�rress unPaid az W •MwtBage / Conract irMebteO�res
Marrh yrAr date o( 3ppfvYv�
H awned wrth somew�e aher than spouse.
Nartre W mMgagrs or mnvacl seYer
Pildress N rt�ortgagee or mntract srAer (nunb� and strea�te, aM LP code)
Name of assi�ee a other avmer w hdder W mortgage ��
Address of assignea (number aM alreet �1: s+e+e, entl Z/P cotle)
Oces appfirent own properry in any othu If yes. what munt�/.+
counry m InEiana? ❑ Yes
❑ No
Deductim app�oveE in �ha amounl of:
�o _
�;�
rwmbu � Page numCu
as o( Is Ihe �pGmnt Ne sde
kgal v MNtade ow�('
n Yes ❑ No
IS the ProO�Y in 0��: MtweP/ As5es5eG
� Real RoPeri' ❑ %��Y �
a�o� r� nc ��.
What Ta�drg Distr'v2? Has inis tleCUaim Daen requestetl m Praperty
Ior current Y�n ❑ Yes ❑ �
. o . _ — v. -. . '
�o_ � Zo_ nrn�v��-�o...r�.Q�.D......,
, .0 3g5� .....
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rr � cin.., � ���.-• C a i d i ..... ...... ... .. . i b
I/ We certfy urWer th enalry of perju� Ihal the above arM foregaing info I(' .�/4(' / 1�O � � t of IrWiana aM
owner I contracl buyer oi ihe atoremeMbned property on date application '4e ���� `"�
�(owner's f� rertre) �/y� � // _ Date (nnnN. daY. Yea�
p�n DYi�J 7� IAJIAQ%Ali 0 I
m t ot appfcani (wmDer stree; tiry, state, and LP mtle)
m
Pddress of aWm�eO pasa� (numbar and sbee; tiry, stafi, enC LP cade)
Date i�%+. daY, Y��