HomeMy WebLinkAboutMortgage_Basham (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION
Stala Form 63]09 (R70 fl1-08)
` � Prasuibed bY �Partnent d Laal GovemmeN Frtun�
INS7RUCTlONS: M
To be fifetl in persm a by mad witlr fhe CounfyAWitor o/ fhe county wherB the poperty is located.
Filing Dates: 7) Real Property: Musf file during the year /or whidi Ihe deduction is sought.
2J MobDe /Marwfe �h Homes not assessed as Real Ploperly: Must fde dunrg fhe tweNe (12) mmths be/ore�bf_ �ir d7 oJ e�q'himar
NetletlucUonis ^ JUIV n LUlf7
See ieverse side far add"6ional ins6udions ar�tl dralificafions
Aoo5canlfovmaumntradGrvv-me '6n�e/�mvdel _ � n . 'c�`-��e.: —1
db'
�aal prapefly as af
d mortgagee ar mntrad seller
4-JW'cXJI. J
MwWaBe /�rtCOniracl mEe6ledness
Ma(rh
le S� 6�
)�V�
as d Morl
dafe
Yes ❑ No
IIOMIBE WIIII SMIBOfIBOU18lIM12115{lWSB. YWIfdIB WIUI Wlqlll
k Ne P��M in Que9ion: MmiaM Assessed
,� Real Property ❑ Mnually Assessed
Addrass d rtnrtgagee a mitad setler (nur�6erand sllaet �'. sfate. artl LP mde)
Name d assigrree or other owrier a Mder d mMgapa
Pdtlress d assignea (num6er and sbee4 aN• sbb. a# LP mtla) ' '_' . __ . -
Ooes aPp6rant am poperty in am� olher M ye
munry m IMiare1 � Yes ❑ No
Dra���ci� NO�.P.9. 9-..°? 5!(o a
amour�
20
20
CaCd iVO.
.....................
� eea�,a� m� reo��a w, m�m
vrtan�yeaR
❑ Yes ❑ No
2(1 20
Date (mmth, tlay, year)
i/ We cerGfy under Ne penalty o( perjury ihat fhe above aM foregcung ui(ormation is We and carrerl and that the appliwnt is a resident of Ind"a� aM
own / mntrad Duyer of Me aforementione0 property on tlate appliration is filed. . .
3 ure (px�vfs fW rwne) .. n n Date (rrronfh. EaY. Y��)
(%rson auUiw¢ed by duh/ esewbd Power d Allomay or by IC 6-1.7-12-0.7
aNhorizeE persan �numbrlandsLCroL �y. sfafe,
(rnorNh.
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