HomeMy WebLinkAboutMortgage_Bradshaw (3)"`�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship vear
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
• - . Sfate Form 43709 (R71 / 6-09) � � � �
�,«. f Presaibetl Oy �epartmenl of Local Govemment France
File Mark
INSTRUCTlONS:
Fwm filed with:
To be filed in person or by mail wifh the Counry Auditor or Counry Recorder o7 Ne wpr�{yvperq thgq�perty is located.
Filirg Dates: 1) Real Pmperty: Must fde during the year /or which Ihe deductlon is SaLJAL� 1 L u 1 I �( ounty Auditnr
2) Mo6Ae / Manufactured Homes rat assessed as Real Property Must fi7e dunng Me hvelve (72) monNs
6efwe March 37 0/ each year Ne deduclion is saghG C.�J. � ❑ Counry Recorder
See reverse side for adtlilional instrucfions and qual�cations. V�
Ihpp6fant(ownei _ buyer-segrewictioqsmre�ersesiee) 165 OUNTYAUDITOR
)`� P - Vc�^ Sl-
.vsse �ue of real papeity as d Mor�qage / Contraa in
arN 1, mm yrar Mamh 7, artem year
ro, whaf Ls his I her e�od shara oi interest?
name on remtl a Eifterent ihan ihat of applicant, uWicate belovr.
31IICOiItUfia'd3f C! V2f15C�Cf
s
ldres of nrm9age� or contraa seuer lmmber aM streeG �lY. sta.e. a�
� /� n RemN/n�um�ber Page numba
—OC�O. _V —1 Ow�� O�OL
unpaid a W Abngage I Convali'uMebteAness unpaid as of Is Ne appOtant Ne sde �
Eate of aDP�� legal or eWi�ade ownM
❑ Yes ❑ No
wiN someorre dher ihan spwsse, iMicate v.ith v�rom
i< �he pmceM" 'uesrion: Mnualty Assessed
Name of assignee or othu owner or hdder ot morigage
Adtl�ess o1 as�ee (numbrl aM stree; tlry, slafe, and LP catle) _
- „�
� Real Pmperty_ ❑ %w2
Dces aPdimnt awn property in any oNU If yes. wfiat munt�R K:�; ;aring DstrifY7 I � FWC i,. �aWacr.Rk1�� requested on Oropeny
munryin IMiana? _ �.for.au+.tvuuan' _ _
❑ Yes ❑ No - ----��- - . — � Yes ❑ No
20 � �
I/ We certify uMer Qie penalry
amer I mntract buyer of Ne af
n �D�(—�b��
� G L�� � �lo P�
Ihat N[
�ed Prc
Pawn auiharaetl Cy duty ezecutetl Powerg/�ttomey or t
Pddress of authoraetl person (numbera�M snee; ci(y, sla