HomeMy WebLinkAboutMortgage_Williford°� STATEMENT OF MORTGAGE OR CONTRACT INDF
FOR DEDUCTION FROM ASSESSED VALUATION
s�e Fo� e3�os (ae i 2a»
S w„ � Presrnbetl by Department of l.ocai Govemmart Finance
Coun Township Year
�r
File Ma
iNSrRUCnoNS: c
To be filed in person oi by mad with the CoulrtyAuditor o/ the cou�y where fhe property is bcated. MAY J 2009
Fd�g Dafes: 1J Real Property: Dunng the 12 months befare June 11 d the year the deducbon is to be eRective. _
2) Mob�7e Harres essessed w/der fC 6-7.1-7: 8ehveen January 15 end Maich 2 of the yea� Me deductim is to be eAective.
See 2verse side 7a eddifionel in56vcGonS aM qualifitations. �a 1�/�
nppiram (ame` W{onf�ad 6uYer - see iestric(ions m
��
his l her exad share d interesl7
If reme an reomd is diRerent Uw� that of
� � � 1
ol• b'-!lo'Uc(d
�,d�ad�s ���b � �r n�ti, i,
Name of rturtgagee or cartrad seller
si3
Address M rtarlgagee a wnlraQ seller (nwnber arM s6eet �'. s6fe, arM LP code)
ot assi9rree a other wrt�er or hdder of morigage
Address of assignee (nrnber end sGee7. dN. 4afe.
Ooes applifanl ovm plopetty in efry olhef I If yes.
tourdy in Ind�are7
❑Yes ❑ No
I R���� PCX �.J-�
is ma �cm�i u� e i�i w��wa ow.�n
❑Yes ❑ No
If rnvned wilh mmeone dher Ihan spouse,
Whal Tawig Ois4ia?
Is Ihe prapeM1y in quesUm:
0 Real Property ❑ Moble Fiort�e pC 61.
Has Uris dedudian bemi requested on property
for aRenl yeaR
❑ Yes ❑ No
COUNTY AUDITOR
Deduction appmved in Ne amwnt af:
p � 20 2q 20 _ 20 _ 20 20 _
Signature of Caunry AudMr C«mry Date (mmfh. daY• Y��
I/ We ce' under the penalry af perjury that the above and kxegoing intorrtiation is W e and corred and that Uie applicants was I were a residen[ of
Indi and wner of fhe aforemenGmed property on March 1, 20
Sig s 1 Date (mantl', daY Y��
sidenl address oi apqicaM (number arM . sfate, anO LP oode) ^ ^
l /
Person aWhor¢ed bY du y esealed Pwrer of Nim�ey ar by IC 61.1-72-.07 Date (month. daY. yea�
Address of aNhor¢ed persan (num6er arM streef, cdy, sfate, and LP oo0e)