HomeMy WebLinkAboutMortgage_Willis (2)� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
S,�,� Prgaihed by DePa�M at Loml GovemmeM Finance �
INSTRUCTIONS: �
To be filed in person w 6y mail with the Counry Auditor o� Counry Recorder o/ the counry where the pioperty is located. � � Z �� U
Fi7ing Dates: f) Real PropeM: Must fde durirq the year for which Ne deduclion is wughG Counry Auditor
2) Mobde /Manufadured Homes rat assessed as Real Property: Must file d�nng Ne fweHe (72) months
6efore March 37 oi each yaar the deduclion is saght. Coun Recorder
See reverse side for addifionaf instnictions arM qualificafions.
( or mrvrad b�u - see an re sda) •
,/� i / GL �// .S
T' Key / kga� dcsaiptvi Recad number Page num6el_
�'�, a`�''� �i ��_ ��� _ o oa iG o- Qa � �� � o a
erarl
at
app9cant, hNiafi oeb�r.
Name at rt�ortgagae or mnvaU se0er I
AGdress d rtnryapm ar mnbact se�er (nwnbe� ab sbeeG
Name M assi�ee or atlref ovmet or halder of rtqrtgage
Addrms of a�gnee (nwnDereM street cdy, Lste, end LF
Y�
�ness unpaid as of Mortgage / Contra
LPCOde)
somear�e
—..�^? �WIalTerifgD'¢trict?
�ess �mpaiE as of Is Ne eppOrant the sole
kgal or eQUttable oxne(1
❑ Yes ❑ No
>OODU, iMi�te with wMm
Is pmperty in OuesUOn: MnuaOy A45esseE
Real Ptoperly ❑ Armually Asse55ed . . _
Has th5 deducGm Oacn rcGUrsteE m pfopelty
for wrtent Y�n 1-'1 .. 1"1 .
D1�:111'(°I� �iQ,��� GOUNTYAUDffOR
ducM ••••• .•
Zp C:11'(j l�i .....!� r0 ......... 20 20 20_ 20
��i ��. �
��Ma of CamN Auditor . Counry oate (rtronth. daY. Y��
I/ We cerOfy untlu Ne penatty of perjury that Ne above and foregoing infortnalion is We and cortecl and ihat ihe applirant is a residertt of Indiare and
owner! mntra�Y buyer ot the afo2merrtianea property on date application is filed.
1�� (owne/s fiA reRe) .. _ Date (rtmfi. daY. Yaa�)
FW resident aOO�s d app�cant Dei and sf+eet �fi: �fe. and ZIP ca
��3a ti. o��.Y'�"'vs ,�wti vr
Persm aufhwrsed Dy OWy ezecuteE Power of ARaney Cy IC 61.1-12-0.7
PddrtSS o( aWw�'¢eC 7e� (numDer aM sfree4 aN• slate. entl ZIP mde)
Date (rrpriN.