HomeMy WebLinkAboutMortgage_Baughn"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year y
_ FOR DEDUCTION FROM ASSESSED VALUATION
• Sfa[e Fwm 43709 (R71 / 6-09)
�' � Presai0ed by DepaMient oi lttal Govemment Frenca
File Mark
INSTRUCTIONS:
To be filed in person or by maii wifh tha CounryAUditw orCounry Recorder o( fhe counry where the property is located. F� � �
FRing Dates: 7) Reel Pmperty. Must fJe dunrg the year for which the deduction is sought � � �
2) Mo6Ae / Manuladured Hanes not assessed as Real Properly: Must fJe dunng Me twelve (72) months
befae Ma�ch 31 oleach year the deduclion is sought. ❑ �"Ty e
See reverse side 7oraddilional instructions and qualfiwtions. Y AUDITOR
Ap t(ownerwcantrae uYer- ea '_" mreverseside) � ^.
T ( ��
Ta ' istrict Ke rwmher / legel desaip' RetoN number Page numba
.,,_��,..«,,. ,�� . ��_ n iy ou o- o 0 0- o � i- o a./ a-0 0 2. 5 3
seC �y4f d mal po�
i 1. a�iPlrt ypr \
what is �a / her e�ct
ie m recaA's Q�Refa
ibact 4dehtedfress unGaid az
than Nat of aPp02n; Inditate below.
Name W mon�8a9� m m�tracl seller
�����,��
Name o1 assi9nea w other owner w MWer m nqrtgage
ALdresspTyssynee(numbeLaqf(speet � slefe�MZl% �
SL.
pnperty in any other If yes. what munt�/1
❑ Yes ❑ No
S
��.
Deduram appmved in tlre amoum
za_ i zo i �
MonBa9e I ContrarY mtlebtedness �mGaid as d Is ihe eCG�� tlia mle
date o( aOP�� legal w equitable v�wrwYi
❑ ves ❑ No
witli sameone ahm Man Wo�. rtmSqfe witt� wMm
Is ihe P�GenY in QuesUOn: Mm�aOy Assessed
[�F%al Property ❑ Mnually f�ssessed . . .
i�Whaf Tari�g D'a4
�uNrvnuoROR
20 2
r� u,s aea�,e� e�, rea�eu�a a, p�m
���� ❑ Yes ❑ No
��BAU�NA, S,a�,c3 W
I�Jl? �PC'�r�' /�
�ao� -as.��
�naWre W Caunty AuAitor c:a�ny . .
I/ We certify under Ne penalry ot perj t the a oregoing infortnation is W e and cortect and Ihat Me app��., __
owner I contract buyer of the aforem � ed property date applicalion is filed.
�ve (�»,�ers ruv,artre) oata (manm. aer. Nean
� A L.% � 7
1 ' ent address d appGrant (number a 4 mY, �te, and ZIP ootle)
�8' !T/ yvs�t/.� ..�t� • U � �f7b6�
rson auttroirzed �y duty exewted Power oflvtomey or by IC G7.1-12-0.7 Date (monN. daY• Y��
1dr¢s a( aWra'ved person (numberaM sbee; dty, state. antl ZIP code) .