HomeMy WebLinkAboutMortgage_Williamson (4)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__, + FOR DEDUCTION FROM ASSESSED VALUATION
� • State Fwm 43709 (Ri t/ 6-09)
�` � pr¢stfip¢tl by Departrtrenl of Lasl Govemment Fi�nce
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INSTRUCTIONS: � ped�ntq
To be filed in person w by mail with the CountyAuditor or County Recorde� o/ the county where the property is located. Fii�1 i � Y� Z� � 2
Fil'mg Dates: 1J Real Properry: Must file dumg the yrear Por which the deductlon is soughL � Co n Auditor
2) Mobde / Manufactured Hortres rrot assessed as Real Pmperty Must file danng the fweNe (12) months C{.:-.p Co ry er
before March 31 of each year the deducfion is sought. LJ
SeereversesideforaddtionalinstrucGOnsandqualificafions. GIBS N
AppGfan rorcontrarl6uyer-s rnrerE side) .
T lg Oisbict Key �wmOer / legaf tlesaiP� Record numbrl Pege numDer
a(o - - v� - o v v. -o �-C� 2�0 � 2- 0,3
Atscssed vahie d 2a1 P�P�Y as of hbr��ape / Cantract intlebtetlr�s unPaid az W Morl8a9e I CantraC uMe6t� �y unp�N as d Is the ePP�^t the sde
Marrii t ame�rt Year Mamh i, w�2nt Y� date oF aPP�katg� ,. /� 6. (l 0 i� � or eWitade ameY1
II no, what h ha ! trer ezaa sl�a�e of intemst?
it name m �ecorA a dMerent tlun that ot aPpl
'lame of rtnrtgagee a cmttaU se0er
Address of rtnr19a9ce or contract seAer
Name of assignee a other owner or hd
pfoperty in any oUer
❑ Yes
O�ucGan app�ared ui the amouni
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numher a d streef, clly, sfate, anE 2
er of rtortga�e
�rty. slate, and ZIP code)
.3-io .
If yes. whet count/t
�t wmea witn
8 A �
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Yes ❑ No
Is tlie W�PenY m Vuestion: Mnuavy As
❑ Res1 qvpeer(Y ❑ ArmuaOy 0.SSE
Mob�le Fiort�e
llra�vei' NO....��1�......
�'ii�� �a�3
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rewre ot Camry Aue�imr Caunry Dam (rtroNh. tlaY. Y��
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I I We certify uMer the penalry oi pe ' Mat the abo nd foregoing informalion is true and cortecl arM that the applinnt is a resident of IMiana aM
owner I wntract buyer of Ne afwem ntimed prope n date appliption is filed.
V!aD+Ie (ownels lull name) : � Data (monlh. daY. Nee�)
Person
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ce�
nE stieet. city, state, and Z/P oot
Fo2r82�un�r-:
#Anorney w by IC 61.742-0.7
stree4 �'�Y• srate. arM Z1P cade)
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