HomeMy WebLinkAboutMortgage_Williams (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun '
_ � FOR DEDUCTION FROM ASSESSED VALUATION
Stdte Fwm 93709 (R77 / 6-09)
� f Presaibed by �epartrtienl of Local Govemmenl Fnance
i
INSTRUC710NS:
To be �led in person or 6y mail with Ihe CountyAuditw or County Recorder o/ the counry whe2 !he properry is located. F�
Filirg Dates: 7) Real Pmperry: Must file during the year /or which the deducCan is sought �
2J Mo6�7e / Manufactumd Homes rwt assessed as Real Properfy Must file dunng the tweNe (12) months
before Marth 31 of each year the deduction is sought. '�
Sae reverse slde !a addifronel instructions and qualifications.
nppfinnt( rorconvartbuyer-seeresnicbonsmreve "e) IB$(
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TaAng Distrrcl • Key rwmber / legal description Record numl
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Asmsed vahc d popertY at d Mortnage / Contraa 4Webtedness unpaitl as W Mortgage / Con7aa'vdebtedrress un7aid as of
�MarM 1. artart year Mard� 1. airtent ynlu date of ap� ���
�
I( ra, what is his / ner exart share ot interest?
If name on remitl is ddferent than Iha� ot appl
rrortgagee a mntract se9er
W mortgagee w mntract se0
Nama o( assignee w othel awner or hdder of morigage
ri(y. sbm, antl LP mde)
naarass ar assgnee �numner aiv suee� ory, sere, arm ur woe�
Does e�imnt am property in eny aNer If yes. what counp?
can+t�i m �maraa ❑ ves
❑ No
NRat Tari�g Distri
20 � 20 � 20 _ � 20 _ � 20
d CamN Auditcr
dher Ihan
�urtv QVditw
1 Re�1�P�
Yes LI No
�tim:MnueOyASSessed
❑ MnualyAssessed
Moble Fiwne (IC G7.
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5�3; � ���9�9R9�
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20 � 20
I I We cert'rfy under Ihe penalty of peryury that Ihe above anA (oregoing infortnalion is We and correcl and thai the applicant is a resident of Indana and
owner I contracf buyer of Ne aforemeirtioned property on date application is filed.
i�WrelowneYS/utlnamel _ n Date(rtontli.daY.yea�
Pason autlwiaec Ey
(number antl stree4 dN. �te, ard
persan (numOer arM sbee; ciry. state, antl LP tode)
�ate (monfA, d3Y. Yee�I
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