HomeMy WebLinkAboutMortgage_Williams (9)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:__ POR DEDUCTION FROM ASSESSED VALUATION
Sbta Fo�m 43709IR71/6-09) .
�' ,.,. Presrnbetl M �epartmetq of Loral GovemmeN Fuume �
File Mark
INSTRUCTIONS:
To be filed in person or 6y mail witA the CountyAUditor or Counry Recorder o/ the counry where the property is located. � C �
Filing Dates: i) Real Property: Must file durirg the yrear fir which the deduclion is sought. � Counry Auditnr
2J Mo6ile /Manufactured Homes not assessed as Real Properly: Must file durirq Nie twelve (12) months - �!�_
before March 37 o)each year Ne deduction is mught. �'�/y� ��Y R��
See reverse side for addiG"onal instrucfbns arM qualificatiuns. � Y AUDITOR
l�ficant(ownerorcaitraU6uYe/-�J�°u++�'�mreverseside) / „ .'1 • _ - .
� �istriG KeY m�dfer / IeBaPoesaiD�+ Remrd num6c Page �wmber
- r- 8- a.�o -�oi. i8 a- o� ao 3� t�
Ats�sed vahx af mal qaperty as d hWr(p�p e/ Contraa indrbtetlr�s unpal0 as of Mortgage / Cantrxs intlebtedrress imPaid as d Is Me sC�+t ihe sole
Mach 1, armn year Mamh i, wrtenty� date of appGCation kgal or equitade awnM
ICJD �Q (� ❑ Yes ❑ No
no, what s ns � trer esaa �are a
nalne
wiM someo� ather than spouse,
Name of rtvrtgagee or mntraU se➢er �' `� ♦ `�/ 1 V 1(•C•�� �/���
� %%I/1
Mdress of rtartgagea w wnbaa se0er (number and sheel, tily, 5a�, LP code)
Name of a4ignea w othnl awner w hdder of mortgage
counry
DeducOOn app�w�.M in Ne amount of:
s(ate, enC LP mCeJ (.��� /
� a
��.����� ��
I No
COUNTY AUDI
Zo i �_ i �
�
zo _
Counry
1L P�GenY in Guesfion: Mnue%AS5es5eE
Real ProPertY ❑ MnUally Assessed
Mobile Flane fIC 6
�
' � ] No
Dra�ver \'O.. o..�.r,...........
c���a �io. ..3!�`�..........
� i c7� a � -
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I I We certify �ifer the penalty of perj that ihe above and foregoing intortnation is We and cortect aM that fhe applicant is a resident of InEiana aM
owner 1 contract buyer of the a(omm � ed property on date appiiption is filed.
(own fs f� rtertre) Date (rtmM, daY. YgaA
, � �r - �/.��
ent� W a �(number and s8ee4 mY, s+ate. and LP cotle)
ql4- C�Si�keta�t,i Dr � �t_Brana�! zlV, �76�F8
Person aWn�aeE Dy tlWy euepIIetl Pwer o(Attomey w by IC 6t.1-12-0.7 Date (mmfh. day. }ea�
of auNO�'¢ed person
antl Z/P cnde)