HomeMy WebLinkAboutMortgage_Williams (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ns Year
,�_,. � FOR DEDUCTION FROM ASSESSED VALUATION
�• State Fortn 43709 (R77 / 6-09)
S 1 Presaibetl EY DeP��M of Lool GwemmeM F`ance
wsraucnoNS: FEB F ��
To 6e lled in person w by mail wifh the CountyAUditw or Counry Recorder of the counry where the properry is located. F� �� ��
Fit6g Dates: i) Real Pioperty: Must fde dunng the yearlw which !he deduction is sought unry Auditw
2) Mo6ile / Manufactured Homes rrot assessed as Real Property: Must f+le dunng the fwefve (72) months� tyR
before March 37 o/eacA year the deduction is sought � UDITOR��d�
Seereversesideloraddj(ionalinstmctionsandqual�wtions. � pIBBON C
1 value ot 2a1 popeny as of
arren[ year
ro. what is his I her exact share oi interesl?
narne on remd ia QAerni[ Nan that o( aPP�. i`M'uate
Name m mMga9ee «
or mno-aa
owner or hdder of rtprt9age
Address o/ asvgnee (number antl stree4 ciry, s+ete,
Oces epplimnt ovm yoperty in an
munrymindiaria? ❑ Y
Dedupion approved 4� tlie amoun
2� _ 20
Sigr�atu d itor
I I We certify urWer Ihe per�
owner / wntracl buyer of tF
��'� I 3� -oo l. Sa d-oa5 I Record num
/ Contracl'uMe6tetlness unpaid as of Mortgage / ConVarl mCebteErress unpaid az ot
ur2rtryeqc, _ date of appGcation
srate. ard LP code)
Dra���er \O.•.°��••••
......
autfwrizeO Dy Auty executed Power
Card NO
dty, state.
wiN sorrieone other ihan spouse.
iitaWe ameR
Yes ❑ No
R tlre praperty in 0�: �nua%Assessed
❑ Real PmPeKY ❑ �!!�Y �
Disvirl? Has Ihis deduction Eeen requestea on proprJty
tor anmt yeaY.+ � Yes ❑ No
a�i�(........ �_ zo 20
....��87, 797, � ���"��'�- I �
_....� .........ww�i i� we�and cortect arW Nat the applipnt is a resident of Indana and
on date appiication is filed.
Date (monfi, day, yaa�
person (numberarMSbeef,dy.stafe.anOLPOOde)
Date (rtronN. QaY• YEa�