HomeMy WebLinkAboutMortgage_KelleySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
_ FOR DEDUCTION FROM ASSESSED VALUATION
sa� � a3�os �» i aos�
,' Prmrnbetl by DepmtrtqN of Loral C»wmmerC Fuw�te
INSTRUCTIONS:
b 6e (ded !n persavi or by mad wrth Ihe CauntyAWdw or Counry Recader o7 the tounN whera Me property is boted.
RTing Datas: 7) Real Propeny: Must fi!e durrrg the year lor whkh fha deducfion is soughf.
2) Mobde / Afanufectumd Homes not essessed as Real Prt�peerty Must Ae dunig Me hvelw (11J monMs
betwe Ma�ch 37 0( eech yeer the deducton is saghG
see re�rerse s,de �or adarwna� �svua;ms em a�aurcanons. �
nop�ca�y{q»,erorwrmsuauyq/-aee mre.e�xside)
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tl nartie m remrtl 6�flereN Umn Nat d appOmnt h�Ckam beJoMc
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�eeress d rt�v�egee or rn�,o-a� ae0e
Of CUIHIOMW IX
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ooes apa� � v�ue�v �� enY o �
mu�LLy in Ind'm�m7 /
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DeducGOn appra+ed F the ennun[ o
tt owned riCi sarnmrie aU�ar
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NTa1 Te
iTY AUDRO
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. ❑ Counry�� der
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�Nty A(/BhT� .
Remd numOx PeBe nmter
unpelE aa d b Ihe eppir�l the ade
i bga� or � aarmll
❑ Y2s ❑ ND
�e xith whom
la tl�e propmty N 0�: �BY AsseyeE
❑ Re� �oae+tr ❑ n�v,uaernsse�ed
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Sgriewre d CanN aknar CwnN
I I We certity undrs tha penatty of pery'ury that the abova and foregWng Infartnation is iri
owner! contraU bu1'er of the aforemerNmed pjoperty on dats aPP�kation is filed.
ffi�a.���� y�� �70
!'h G.�i� �
tr/ d�ly eseculed Paver o(Atlamey m by IC �1.1-12�.7
Address d auC�ortred prlsm (iwrnber end mtlBt �1: ffire. end LP Ntle)
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