HomeMy WebLinkAboutMortgage_Williams (16).a °•n STATEMENT OF MORTGAGE OR CONTRACT INDI
- FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fartn 43709 (R8/ 2-07) ,q,O
�° �� `i Presaibed by DepaM1ment of Local Govemment Finance`T
Coun[ Township Year
�`I �� g��
�1�U U
iNSrnucnoNS: APR � . C u
To be fiied in person or by mad wifh the CountyAudrtor o( the county whert the property is located.
Fd'o�g Dates: 1 f Real Property: Dunng fhe 12 monfhs before June 17 of the year the deduction is fo be etfective. �
2) Mobife Harres assessed under IC 6-1.1-7: Behveen January 15 and March 2 olthe year the deduction�ge.e�
See reverse side fa additional instnictions arrd qualifications. Q
r_iac[�N COUNTY AUDI70R
6yrer - see ie4iiclions m raverse si
Key number / legal desaiF
a,/_i�_i�.
Asses,zd ralue of mal poperiy as of Mardi i, aarent y�r
otinterest?
drfFerenl Ihan Uiat of applicant, iMinte helow:
Name of rtnrtgagee or cant+aU seller
-r/- ooa-ol �-o� aoo£f �/33
/ Contract iMeMedness unpaid of March 7, Is �he applipnt Ihe sole legal a equitada wme(1
ar /p0a �Yes ❑No
IF ow�ried wAh someane olher �han spcwse, indirate wilh whom.
Is Ihe properiy in quasUon:
�1 eal Prpperty ❑ Mobile Hwne (IC G 7.
Address of morigagce w mnUad seller (number aid sfreel. aty. sfate. arM ZIP code)
Name of assignee w otlrer owner ar holder of mortgage
UI'H�1'CC 1�'�.'� '
Address of assignee (��� � sUeef. city; sfa(e. and ZIP code) �. ........
. �
Ooes applicanl own poperty in arry oUer If yes, whal counry? c�,�� �� o. ..,..Y. 33 �-�
counry in Indiana? � �
❑Yes ❑ No .............
� I $� p ��. o'I
co�... . . . '—'
ctmn apprwe0 in 1he amaunt of:
2p Q� 2b � 20 20 _ 20 20
, .aa��a o� woxny
❑ Yes ❑ No
tlay,
20 _
I/ We certify under the penalty of perjury that the above and fwegoing infortnation is true and correU and that Uie applicants was I were a resident of
Indiana and owner of ihe atoremer�6oned property on March 1, 20
�ra4ue (owners fiAI n me) ' Date (mon(h, Jay, .
�h�.�-��- l,Jc,Gl�.�� y- aZ- �'
3 Sbu
wrized by duly
. (num6er and:Ueel. dfy. sfate,
Power of Altomey w by
Addrrss of euUnr¢etl pason (num6er aM sheet. cify, state, arM LP mde)
N 7 / C¢ �0
(mmth. daY.Y��)