HomeMy WebLinkAboutMortgage_Walther (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION
� sr�a r-o�„ as�os (rtn i s�as�
�' ,�,� f P25vi0eG M OeV�+�M of La�al GoremmeM Fuisnce -
F'
INSTRUCTIONS: �F�pr�py1
To be lled in person or by mail wdh tne CounryAUdirw or Counry Recorder o� the counry where the property is located. � p y� z Q�Q
Fil'mg Dates: 1) Real Pioperty: Must �le during Ne }rea� )or which the deduction is soughL �� �� � County Auditor
2) Mo6de / ManuFacturetl Homes rrot assessed as Real Property: Must fiie dunng the tweHe (12) months
befora March 37 0/ each year the deduction is swght ^ e�d
See raverse side for additional inshuctbns arM qualifications.
A�{ otb ' �
ea raLe a real aopertr � d
1, ariaM yPar
rhat Is his / Frer erad share ot u
3 m remtl'a 6ftrJmt W n Ma
ot mortgagee «cmtract seAer
"�iU'1'UVV•JID l'I
hbr(gage/ Contraa "vitleMeOness unpaid as d
Ma� 1, a�rent year
Addrm of rtartrJa9� a contran srder lnunNei eM sveeC �GY, sbte.
Name of assignea w other ovmer or hddar of mortgage
Me�s at avagnee (numbar erM snee4 �: stete.
epplimnt axn properry in any omer
y m IMana? �
❑ Yes
� evw� m me a�,m or.
�_ �_
rc o�maa �m
�'�'�"
Remrtf
uWebtedness un0� as o! Is Ne appfrant tlx sde
kpal «e4���ae o»nen
, ❑ Yes ❑ No
han spouse. udimte with whom
„ Drawcr NO.oc�.i/.�.........
No
Card NO. ... ��'�![p.......
��,,,Q ��n�i 4' ROxQnr��.t.
� 513 �3o�k ��� � . eA �AQ.t
Caunry
Is Cie poperty in puestion: Aruwa%Assessetl
❑ Real Provenv ❑ nrmua�N assessed
Abbile Hartie fIC 6
t6 dEdUC9M EBGf1 RQUMtPl� OIl ptOQGlf/
nent yeaR � Y2S ❑
F.����r,
I/ We cenify uMer ihe penatty of perjury that Ne above aM fomgoing intortnation is we and cortea arW that Ne applicant is a resident of IrWiara aM
owner I contracl buyer ot the a(o2mentimed P�PenY � date aPplication is fiied.
�naWra Mlname) . i � Date(rm�N.daY.Y�/i
Gy dWy ezery�d Po+et of Atfomey or Cy
person (number a� snete4 �/�Y. stale.
�l: l��)