HomeMy WebLinkAboutMortgage_Woods (5)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.--
; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Farm 43709 (R11 / 6-09)
4' ,�,� l P2saihH by DeparlmeM of Loral GoremmeM Fitwx.�e
File Mark
�STRUCl10NS: F� ��
To 6e filed in person or 6y mail with the CountyAurlitor or Counry Recorder of the coun e t pro s 1� t
Filirg Dates: 7J Real Property: Must fiie tlunrg fhe year (w whirh the deduction is so ht. ��� q p' � unry Auditor
2) Mo6de /Manufactured Homes rat assessed as Real Property Must �Je dunng e )-hfertsis
6efore March 37 of each year the deduclion is sought. ❑ Cwmry Recorder
See reverse side for addi�ionel inshuctions antl qualificafiona � E � 1 4 Z � I �
i °r �..� �`� M � �'sa sd_`l�. .. C .'�. M...'Y`..= _. .
AsesseC vaNe d rPal pfopsty as d
M2rt3� 1. tlm�nt ytlr
II no, what is his / her exatl share of intemsl?
���— 10 —I O�� OV •�
Mwtgage f �c't@ i/riEehtednass unpaid az W
MatCh 1. al I�^�., T' 1
`JCJI V
11 fume m iemfd'¢ QfHe�ent Ihan Nat o( aPP��.
se�er (num6er and sfreet, city, s1a:e. aM
w�as, msc� A�z. �-
ir-��s5
approred u� the amaunt of.
20 _ � 20
I/ We certify uMer Ne penalry of perjury that
owner / wntract buyer of the aforementioned
Inawre{ownerYhAreme) _ . . n. �n
20
at
arb Fc
n date
tlry, slste, end
Ey O�dy ezecutetl Power o/ Attomey or by
person (numberentl sbaef, dty. sfefe. an0 ZIP mde)
Retord number
Mwlgage / Contra�2'uWebtedness unOaiE az o! Is Me aPW�t Ne sde
date of appfxation legal w eWilable avrtrl.�
❑ Yes ❑ No
rc wmea wim samea,e aa,w �ma� sw�+�. ��e wiu, wMn,
Wtal Tad�g DStriC?
GOUNTYAUDROR
20 _ 20 _
_ �^ty ..
Is IM P�PenY in Vuestion: Mm�80Y Assessetl
❑ Real ProPeKY ❑ %��Y �
r�� r� nc ��.
Has Na deEUCTian Deen requeSteE m ptoperty
m� w�� y�n �
❑ Yes
ZO � 20
in(ortnation is W e and cwrec[ arW that ihe applinnt is a resident of Irdiana antl
ion is filed.
IDate (rturvh, EaY. Yaa�)
7a
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