HomeMy WebLinkAboutMortgage_Berry (2)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R11 / fi-09)
�• d PresciEeE by DePM�rtl of Lcwl GovemmeM Firence
ur
I
�srRUCnoNS:
Fortn f�ed w1Bh:
To be filed in person w by mail wiN the CounryAuditw or County Recorder o� the county where the propeAy is located� O V 9 01
Fii"mg Dates: 7) Real Pmperty Must �le dunrg the year (or which the deduction is sought. a �unry Auditor
2J Mo6ile / Manulactured Homes rrot assessed as Real Property: Must file during fhe lwelve (12) months
before March 37 of each year the deduction is sought C.'�. unty Recorder
See reverse side foraddifional instructions arW qualfications.
Ap wrerorcon0artbuye,�-see2svicL'onsynreverseside) ^ . �
Tavng �istr�ct
�y ����
IMarU 7. dlmnt �ear
If ro, whai rs Itis / hef esact
If rame m recwtl is Eifle�u
Key nimber! legal desaip6on / Reco�d m�mbr! Page rwmbu
-/D-.��O-3oa -oo�. � 3-0� 2�a1 34y9
�C9a9e / Contract iMebteCrress unpaid as W Mortga9e / Con:rac7'vNebtetlness �m7aid as d Is tlre aPP�t tlu sde
Marrh 1. airtejm year �/� tlate af appfratnn legal a epuitade owrel?
d D [JV ❑ Yes ❑ No
itrsrst? tt owned with sameone dtrer Ihan spouu. udirate wuh whom
Nat of aPP�^L oWicale 6ebw:
Name of rtnrtgagee or mnlraG SNIer
nearess m monqay� «
Name o( asvgnee w
rtprtgage
sram.
Is the property in Question: Mnua�y PssessM
❑ Real Property ❑ ArmuallyPssessed
Mohile Hane (IC 61.
Pddfess of assignee (nu rand slreet �: slate, and ZIP code)
�i' � SGJ 36-�-/a- 8.08� AL
Ooes applimnt own property in any dher It yes. what counq? Wlut Ta�drg Distr�? Has Ihe OMuCian Ecen requested m pmperty
counfy m IMana?. � Yes ❑ No - __ � � �� ❑ Yes ❑ No
COUNTY AUDITOR
DetlucGm approreC in Ne amount
zo _ � zo _ � zo � zo _
Counry
_ Dra�verNO..�?���.
� ........
— Card NO�.j .....�J.�y�
— �1 `tit/. iD ..... ...
I/ We certfy under Ne p�a�ry of perjury�tbat the ahove arW (oregoing infwmation is true and correc[ afw ua, ��.. _�,_- , '�:
owner I contraa 6uyer of the at«emenliSfied property on da[e aPWicabon is filed. �
�rew rs nartre) Qata (imIIh. daY. Y��
II nt of appfxant (numbe� nd sheet, vl}; sFate, antl e) �
���' .� �-�OC� `5 CvP��2�x�o �,(� �7� �s
rson auUwraed Dy duty ezecuted Power of Attomey rn Oy IC 67.1-12-0.7 Date (monN, day, year)
Pdtl�ss W auNor¢etl persm (numbera� sveeC cay. sfate,