HomeMy WebLinkAboutMortgage_McKee"'� STATEMENT OF MORTGAGE OR C IND �NE�SS Coun Township vear
, FOR DEDUCTION FROM ASSESS VA U�1��.J
Stace fortn a3709 (Rt t/ 609)
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1 File Mark
INSTRUCTIONS:
Fortn t�ed wtth:
To 6e tded in person or 6y mail with fhe CounryAuditor or County Recorder-o[1pe muntpy?�te the property is located.
Fd'ng Dates: i) Real Pmperty: Must file dunig Ne year for which Ihe dedy�E�d ffyliG� ��Counry Auditor
2) Afo6de /Man Wactured Homes not assessed as Real Property�t file d�elve (12) months
before March 37 of each year the deducAOn is so�gSON CO NT r ❑ counry Remrder
See reverse side /or addit6onal inshuctions and qualfications.
�owm�, �o � b�,-l�� �"I . �� � %� � � /
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� TariiwOTtrCC �" Kev numErs / lea desaintia� _ �Remfd nwnbu Page number _
7 mq[i' —O � o!" J• �
AssesseE ra4c U�eal {toper;y as ot M1brtgage / Cantra� irdebted�s unPaid as of
Martii 1. tlmnt year MaTh 1, tUrtent year
n �o. wnat s nrs � ner eaaa :nara or mteresn
Ii name on iemld s dRterent Nan Nat ol a0p�nl, uMit
Hame m morta��e ('P/ OYX/J �
Pdd(ess d rtnrtgagce «cantrad sWer (nuMr1 and sa
Nan,e m sstignee or ah� owner or naae. a matgage
Mar�s of asag�me (numEer erd atraet �Y: sfete, an0
Dces aQptirant ovm pmperty in any oNc
munry m IMana?
❑ Yes ❑ No
Deaudion approve0 In Me amount af.
20 _
Sigrenrta d Ca�mb Aud'rtar
20 � 20
y, sfate. and LP wde)
iEe)
wfiat muntY? What Tarin
COUNTYAUDROR
_ 20 _ 20
Caunty
ss unPald as o( Is Ne ePP�^� ihe =^,°
legal w equilade bw�u(?
❑ Yes ❑ No
e. trMimte with Miwm
P�PenY in Ouestim: Mnuaoy Assessed
� �xnY ❑ ��Y�
Drawer NO...�°�.1.��..........
Card NO. ....���••'......
20 _ � 20 _
�Y.Y��
I I We certify urWer Ne penalty ot perjury Mat Ne above arW foregoing infom�aGon is W e and cortect arM that the applicant is a resident of IrWiana aM
owner I contraU buyer of the afaementioned property on date appliration is fileC.
�re4ve lawoerS N9 rerrel . . _ n _ / / � (�. �Y. Yaa�
�/��� � o c�
d appGtant (numder aM 5Lee4 �: sfate. ?nd LP mtle)
� F,Y,n.s St %:ivliof��n
Person aW�arseE by dWy eaeatetl
P4Cr�s of autlwr'¢ed 7� (numba�and sbee4 �: state. anALP mde)
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o� ��brvn. dar. r�