HomeMy WebLinkAboutMortgage_Dodge"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
__ . s FOR DEDUCTION FROM ASSESSED VALUATION
• • State Fortn 43709 (Rtt / 6-09) � T�
�' �w j Presaibed 6y Oepartmerrt ol Loml Govemmem firence �
File Mark
wsrnucnoNS:
Fortn Ned wiih:
To 6e hled in person w by mail wifh fhe CounryAudifor or County Recorder o/ the oounty whe2 trye�pppgty �,sl��d
FRirg Dates: 7) Real Property Must hle durirg the }rear for whirh the deduction is soughL J C f� O� C U I I Counry Audimr
2J Mobde /Manulactured Homes rrot assessed as Real Prnperty Must fiie dunng Me tweHe'(12J months
before March 37 of each year Ne dedirction is saqht. C_�. Counry Recordu
See 2verse yde r additionel insfiictions and quali�cations.
Mv���nf �x�-�re�^s K sd S N Y ITOR
is Key numCer / lega 'ptian � Reco�d numEer Page number
Q 6-(� �f -��"k� OC27 , v�'j /-0 d
vdhie of real poperty as d Martpage / Contract iMehteEness unpaid as of Mortgage / Convarl indebteAness unpaiE az of is �he app0�ant Ne sole
Mamh 7, nnent yrar March 1, arrent yeer Eat¢ of ap ' legal w epuitade ameR
�f rm. what fs his I her exatl share oi intemst?
It name on remrtl's dttuent Nan ihat W apP��. �inta Gelow.
Name of mortgagee w mntract seller
Aildress of rtnrtgagce w contraG se0er
Name ot assignee w oNer owner w hd
Address of assigfree (number arrtl stree4
Dces aPd�nl wm pmperty in any other
caunry in Intla`u?
❑ Yes
crty, stata.
u M mortgage
cdy, slete. and LP code)
If yes. what tount�t
❑ No
cbon apprwe0 in Ihe amouN ot
20 20 20
20
� % ��v ❑ Yes ❑ No
v,.,....e.�..:.. ""__""__..__..__'_ __._°—_
aoi►- 3qy�
[�R �uc�, � �DG E
1�� 1 � il=+i •.�T F-/ V tiiO �
1M�at Ta �/ 2 I� /`� �
J
�l �i, �y0 �'
4UDR�
1/ We certify under the penalry 6f perjury that tl�e above and fo o infortnation is �
owner / mntract buyu of ihe aforemeniioned pmperty on date p lion is fiied.
�naeue (oxne/sl�nartre) // 4_
�G�fv`2.�–o--Y �L ��e�-�6iC
11 revdent atlCrrss of a numDer antl shee; � te, and ZIP aode)
Person aWmved Gy duly ezewted Power W AttorneYyF by IC G7.1-12-0.7
Address of aNhoraetl person (number arnd sbce; city, sbfe, aM LP code)
70
i
v