HomeMy WebLinkAboutMortgage_Bedwell (2),
"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R71 / 6-09)
` Resoibed by �epartment of I.ocal Govemment France
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INSTRUCTIONS:
To be filed in person or by mail with fhe CountyAUditor or Counry Recader of the oounty where fhe properry is bcat ��
Fil'mg Dates: i) Real Pmperty: Must file dunng the }rear (or which Ne deduction is sought. Counry itor
2J Mob�7e / Manulactured Homes irot assessed as Real Property: Must file dunng the (wefve (72) months
betae March 31 of each year the deduction is sought. C T 4� Oo�xKV Reeorder
LUIC
See reverse side for additional inshudions arM qual�cafions. ,�
AppGc�nt (.°.wl�°r conba�{ buyer- � 2slncLOns on�e%rse 5��) . . /i � /! n . /1 /%
descriDtion
/.3 _/�/- 00/ //3 _
at is his / twi eraa share of interest?
m�cord's d�ferent Nan that of aDpOCant, m0icate below.
act inCe6teEness unpaitl az N Mortgage I ebtednrss unpaid as d Is Ne epp�cant the sde
yenr date of aP � legal w equitade o�md1
❑ Yes ❑ No
If ovrtred with someane r ihan spouse. Indicate with wtrom
Is prope,rtyinqurstion:Mnua�yAssesud
Real ProPeRY ❑ AfII11!�.Y %�� . . _
Name W mort8ag�.'e a contraG seller �/�
Atldres of nnrtgagee or wntraG se0er (nvriber a slreeL �}: slate,
Name of assi9nee w other owner w hdCer of rtprtgage
AEtlress of assig�e (nurnber aM stree4 �: sb1e, and Z/P tode)/;)
r
lif!
Docs applitant o-xn properry in any other Ii yes. what m
counrymindau? 1—I ..__ i—I .._
oE
20 � 20 � 20
� � i ��Q �
� a�dng Distrid7 N's Eetlutlrc
a,nen� yean
COUNTV AUDITOR
20 _
I/ We certify uMer the penalry of perjury Nat Ne above and (oregoing infortnation
ov.mer I contracl buyer ot the aforementioned property on date appiication is filed.
���J,�,r„�c' e
Pason autM�¢ea oy
ce�
�1 4�+N, �te. eM LP aotle)
,Br2nG� , �N �/
a�er or oy ic �,.,-,�-0.�
ree4 u�: slate. arM LP code)
20_ I 20_
2questeA m proprlry
❑ Yes ❑
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