HomeMy WebLinkAboutMortgage_Williamson"�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION
� � State Fortn 43709 (R71 / 6-09)
�` ,�,� PrewiGed by DepartmeM of Lool GwemmeM Fuance
ieM
INSTRUCTIONS: yy
To be filed in person w by mail with the Counry Auditor or Counry Recorder o/ Ne county where the property is located. F� �� ��JN p�f ,n
Filirg Dates: 7J Real Pmperty: Must fJe durirg the year for which the deducLOn is sought. � Counry Audi�Y � �
2) Mo6ile /Manufactured Homes raf assessed as Real Pruperly Must file dunrg the tweHe (12J months
befae March 37 of each year the deduction is sought ❑�B� e1
See reverse side foraddit6onel instmcUons and qualifications. G�
npp5mnt(yqie;orcontractbya�-see strlrtiorismreversesee) AUDIT
,��e .� a � o�r as a
Irch7.tlmvrtyear
�� M. W�Id� 6�115 � hff 2lldG Si12l8 Oi VIiBlPSl�
If name m recdd is dAlemnt Nan Ihat o( appl
Name ot nqrt9agee or conUaG seller
�
Mdress of rtartga9ce w mnVaG sWu (num
Name of assignea w othPi owner or holder of
Address of assignee (number aM street �1:
Does appli�2M own pmperty in any other
munry in IMana? ❑ Y2s �
p¢duction apprwed'e� Ure amoum ot
�_ , �
-ly l5'- /a/-�ao
Mortgage / Conbaa iMebtetlness
MetCh 1, a�rtent year
ant, UMinte bebw.
/�
rl and sLeel, cM ��. an0 Z/P oode
rtpngage
slefe. erH ZIP cotle)
II yes. N
N�
: �a� � _a�
f Mortgage I CrnVaa indebted�ress unpaid as of Is Ne appGont Ne sale
dare of appGration lega� w eQuitahle ow�R
❑ Yes ❑ No
H owneE vrith mmeo�re other Nan sPa+�, in0icate with whom
11— �g9c�
�_
1 �5 `�qQ °°
Sune.io ao�1
—, Qet�rded .��ne �S�ao�t
Is ihe properry in Question: Mnua�y As¢ssed
� Real P'oPeKY ❑ %��!�N �
— ��u�na�ra
du�irn been iepuestetl an P�Y
� ❑ ves ❑
� �
.._�e (�nrn. ear r�A
I I We certify u�er the penatly of perjury that Ne above antl foregoing infortnatio� is true and cortect and Nat Me applimnt is a resident ot Indiana aM
owner I conVact buyer of the afwementbned properry on date applicaUOn is filed.
Signa fslu0reme) Date(rrontl�.daY•Y��
� F resident atltlress d appficant (number ard sfieef, dry, state, anALP wde)
n3 E ��ee-F . c'a =N Ll7
PelSOri authorized Gy GWj ezecuted Power al AttwneY a�' IC G1.1-12-0.7 �(��. �Y Y��)
De�� InumberaMSbeeLa+Y.state.