HomeMy WebLinkAboutMortgage_BedwellSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 13109 (R70 /71-08) � 1
� w. � Presaibed bY �rtnient d Loc� Govemment Fuunte 1'
!
INSTRUCTIONS: Fle Mark '
To be filed in person a by mad witli fhe CountyAWifw d fhe caunty where tAe property is located. C
Filirg Dates: 1J Rea/ PropeAy: Mtttt Be dure�g fhe yeai hx which the deduction is soughG �UN �/ 2009
2) Mob�le / Manulactured Homes not assesseA as Real Property: Must fi/e dunrq tl�e lweNe (12) months be7ore March 310l each year
the tletlutlion is sought.
see reverse siae n�. eaePional rnsweior.s end v��fi�fions �a`� .Qifi .
IAppGCam »nervmwad C/ �
ii _ _ �' �}m.sniefms �wrm siael . ^ %� /) n /i ��Y AUD!TnR �
a�a� t. nurem yaar
ro. what 5 hu / her exad share N i�iast7
rrame an `emrtl is d�aranl than Ihal o(apV��l itdimle Eebr..
n
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Nama d essigrree m o9ier ow(rer a holdm of moatpape
dty, afaFa. a�M ZIP wde)
Ind�arel
Dedudian appfoved in Ihe amour�t d:
� ,340-040.
ae'vieeaeaness unpaia es or
year
-U / " `i`Y
�/ CoNrad in 6fedness un{aid as d Is lhe app&ant Ihe sda
pplimye Iegai a equitable wmeR
6 ❑ Yes ❑ No
at��er spouse. iMirate wiN whpn
k Ihe WuOertY in cryeatian: AmuaOy Auessed
❑ Real PropaAy Q Mnualy Assessed
-� -
Wt� Taz'ug Distr
COUNTY AUDITOR
20 �1 � 20 � 20 _ � 20 � 20
aoc�......
DI'�\5'Ci' ��.......•
a���........
c���a �o. ........
Y��I��
ZO 1 20
Signalure d CouMY Audda I Camh I Date (nn^t14 daY, Y�) ..
1/We certify uM� Ihe penairy of peljury Uia� Ne above and foregarg u�fomiation is We a� correci and that �he applicant is a resident W Indiara and'�
owner / contrad buyer of Uie afarementionetl property on tlate applifatiwi is filed.
�natura (owsm�s fiO name) P. � n�i Dala (manflt daY• N'�)
F W FeSiEent aOE�ess of aPWicant (mmDer aM sboof. cIN. sb�.
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petsan (nvnbaantl
Data (rnaVh. OaY. Y�d