HomeMy WebLinkAboutMortgage_Williams (18)^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship vear
: FOR DEDUCTION FROM ASSESSED VALU�� �
r� �
• State Fortn 43709 (R71 / fiW)
S i p��p� py pe�rtmenl af Lopl Govemmenl Firence
"" File Mark
wsrRUCnoNS: 'I c� �;1�
To 6e filed in rson w b mail wiN the Coun Auditof or Coun Recorder o/ the co F� �� ��
Pe Y �Y N �H' �ei'e lhaluv�rty is located.
Fitirg Dates: 7) Real P�operry: Must �ile dunng the }rear for which the tleduction is soughL � Counry Audimr
2J Mo6i/e / Manufactured Homes not assessed as Real Pmperty: MusKffi�,d _ e e[72) monfhs
6efae March 31 of each year the deduction is saqht. County Recorder
See reverse side (oradUifronal instruc7ions and qualifications. G�B
Aoofranifowneror 6uVer-SeeresV{:1iwa re rsesqle) n n � /j /J
Assessed vWue U�
MaM� 1. arRnt yPar
�( f10.'M�Id� 6 �iK i �IC
�ilW�C pllC(�(d 6
Wt of appGrant, u�tli�afe
urnwrcqapee«con,aasener .
Address of mort9a9ee w mnbac[
cily, state,
_c�
ness unpaid as ot
Q ��
Name of assignee w oNer owner or hdtler o1 mortgage
pd(—'�'• ^-•w� fnumbere� sheet �: �, e� Z/P cade)
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m
— Di•a�ver 1\`O. °��la.
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°' c���� ���o. 175��
' _ � l q �� ��.x�.o-� .......... �
I I We certity unCer the penalry o( perjury Ne above ana fore
owner f contract buyer of the afwemention property on date a�
`Sig,re,Ny��,q�n ersluU�me)
VJ ///n/h' ��
1 ent addmss ot applvant (number antl stree4 G4: �te, aml Z/P ca
�Q 6827 5 5a� E �iii- fi/�waG,
Perswi autfror¢ed by tluty ezewted Power W ActorneY a�' IC G7.7-12-0.7
Addr�s ot authwrzed per:.on (number antl stree4 cHy, sbfe, an4 ZIP code)
Whet Ta�dtg D¢Inct?
orttl nu Page numb�
9S/-� `�ora � U(�
maU iMeMedness unPaid as d Is Ihe eGG�^t the sde
ion legal or equilabie ovme/!
❑ Yes ❑ No
spouse. indicate wilh xdwm
Is Me PmGenY in Vuestion: Mnuelly Asse55eE
�1 Reai �ae_m_in,n�u,an�,assess�a
m pioperty
zo � zo � zo_ � 20
�.-ra
irtnation is true and cortec[ arM that the appliqnt is a resident of Indiana aM
is filed.
Date (maah. daY.1'eaA
day, rea�