HomeMy WebLinkAboutMortgage_Holmes"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION �
� State Fwm 03709/R71 / 6-09)
� u� ? Presaibed by DepMment W loral GovemmeM Fuiance
Fi�e-Me
wsrRUCnoNS: 5
k be fi/ed in person or by mail with the CountyAuditor or Counry RewNer of the counry where the property is IocateJ� C T l�fl�
Filing Dates: i) Real Pmperty: Must file dunng the year for whicA fhe deduction is sought Q County Auditor
2) Mo6ite / Manufadured Homes rrot assessed as Real Property Must file dunng the twelve (72J months
before Ma�di 31 0/ eacA year the deduction is sayht "Y� Q� Counry Recorder
�/ �(6 _ ,S. /1a-r�
See reverse side fof adtlitional instnictbns arM qualilrcafaons. �� i�
Fi1FRPiJ Pc� su .,tlB�TG�
I Appfirant (owne�oontrart buNer - spn resficeortpm reverse sde) � C / „ ) '--�
0�
If rWne on Rwrd
Key numher / legal d�aiporn
,��-��-��-�
IMortpage / Contraa u
Mam}� 7, artent ynar
Name of rtrort9a9ee or contraa seller /'y
CF�
Addrea of �mtgagee ar mntract seAer (numbe�
Name ol azignee w ofher owner w haNer d mc
rt assignee (numDer a� s0ea4 �y, slete.
6mnt avm property in any oNer
����
❑ Yes ❑ No
Deaud'mn approved m the amount of.
Delaw
cdy, smte,
If yes. what muny7
zo— I �— �°—
s9�n�re d co�mb rwa�wr
I I We certify under ihe penalry of perjury Mal the above arW (oreg�
owyler / contract buyer of Ihe aforementroned property on date apF
and Z!P mde,
az
If
Reoorti number Pape numEu
_� a-6 �a� g 3 6
�rigage / ConraG'uWe6tednrss unpaitl as of Is Ne appOcant Me sde
x of aPP��� � � w epuitahle ame(?
❑ Yes ❑ No
� someone other than spouse, indicata with whorn
Is Me P�PenY in VueStion: Mm�2�Y PsseSV.E
�ga� RoPerty ❑ %wiva�y Assessed . _
� A?(Oh � �(aQir�.e�
( V ��
�
'� a ooq_ 53yo
� a�9, agq_ ��
CSI. Computcr System�, Inc.
866-913-4160
��4M m P�W�Y
�
��
dent of IrWiana aM
: rean
Person auCw�rseO Ey Euty ezecuud Power of AttomeY a M IC 61.7-12-0.7 - I Date (rtmN, day, yee�
ACdress ot airtlqr'ved person (number and sfreet rity. state, aiW LP m0e) .