HomeMy WebLinkAboutMortgage_Richardson (5)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yeat
� FOR DEDUCTION FROM ASSESSED VALUATION
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� Slate Fwm 43709 (R71 / 609)
�' � PresaibeC by DePa��M of Local Govemrtrent Firence
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NsrRUCnoNS:
To 6e filed in person or 6y mail wifh fhe CounryAUditer or Counry RecoNer ol the county where the property is located. F.pi
Filirg Dates: 7) Real Propeiry: Must file dunrg the year for which !he deducfion is sought.
2� Mo6ile / Manufactured Homes rrot assessed as Real Property: Must file dunng the (weNe (72J months C
before March 31 of each year Ne deduclion is sought.
See reverse side 7of additional instmctions and aualifiratmns_ _.___.
desmption
,�,�d�,���
laamh 1. aarent yPar
If m, what a Iris / her e�act SAare ot inte'esl?
name m �ecoN a 6fterent Nan Ihat ol appOmnt, uMinte bebw.
A4tltes5 of �rortpa9ee
Name of assignee or aNc owrrer w hdder of rtnrtgage
Auditor
� i -oo o ��-oa �'
act'viCe6teCnesS unpaid as of Mortgaye / Can7aU uMebteCn¢s �mptiC as of Is Me app5tant the sok
year date ,ofj p ' legal w epuitade ovmeR
�0 7` �d ❑ res ❑ No
If owned with someorie ott�er Can . iMiqte wifh whom
state.
q••--_ .••.,«:.�m l.uunhrr arM strre4.�l: vate. anC ZlP cade) i
� �ll..s-YT7LV� /�1 /YLCCNAt1 � tmuny?
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Sig�nne W CambnWitor
DNn/�
2�
k Ihe pfopelty in puestion: Mnua�y Asusse0
�Rea�aroaem ❑a,nua�yassessea
m deeuaan oeen rea�stea a, o�m�
�rre�� rear.
❑ Yes ❑ No
20 I 20
I/ We certify under ihe penaly of perjury Nat Ne above and foregoing infortnation is we and cortect arW that the applipnt is a resident of IrWiana arW
owner I contrac� buyer of ihe aforemen0oned property on date application is filed.
�Sig`awre (owner h� na ) Date (rtmfi. daY• Y��
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� IFWresitlentaddress a t num0erandsUee tlry,stafe,a� IPmde)�. �
30� /% ��-7x ,�ve /i'r�<e/o.� .1�'),
Person autho�rzed by dWy exeW ted Porer W AttomeY or by IC 61 _1-12-0 7 Date (rtpmh. tlay, ysa�
PdCress of aWmersetl person (num0ei aM stree4 d+Y, sb(e, antl