HomeMy WebLinkAboutMortgage_Painter^'�o STATEMENT OF MORTGAGE OR CON�C�► I��� Coun Township Year �
.��,. : FOR DEDUCTION FROM ASSESSED V��UAcF1�rT
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� File Mark
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To be filed in person or by mad vnth the CowityAWito� or Counry Recorde� o/ the caunty wh fh perry �s bcated. F� �� �'
Fifilg Dates: 1) Real Pmperty Must fi!e dufig the yearlorwhich tha deducfion is s�o{�gp 7Y AUDI7UF ��unryAuditor
2) Mo6Re /Manufactured Homes not assessed as Real Prc�}g��Ria�l�li1�'�nng the hvefve (72) months
6ehue March 31 of exh year the deducfion is soughL ❑ County Recorder
See reversa side fnr addifronal instructrons arrd gualifications. � •
Key ruenbell
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I( name m remrd's 6Remn[ Nan Ihat of appGCant, u�0ipte
Name ot mongzgee or conrae seAer
Addres of rtartgagee or
of assignee (number arrd sLeeG �
Dces applinm awn pmpeny in any othu
ca,�uy��ma�aa r-� ..--
PZ9
Sigrenne
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' � b0� ' l (DV- O �1 �� � r} P�e�D�
itedness unpaid as ot Mortgage / Con;rad indehtedness unpaid as d Is Ne appfiwit Na sole
�� date of aPP�m� �e9a� w equitahle ameYl
❑ Yes ❑ No
tl awned wiN someone ahu tlian sDO�. 6d'xate wiMi whom
Is ihe pmperty in questlm: MnuaM Pssessed
❑ Real Propertv ❑ lvmuaM Assessed . . _.
tdy, atate, ard LP mda)
P����, P�.� v�
7
l� -5�01� �� ������,�������,o�
for artent yeaR
❑ Yes ❑ No
20 � 20 � 20 _ � 20 _ � 20
Date (rtwnth, day,
I/ We certty under the penalry ot perjury that the above arW foregoing intortnation is true and corteU arW ihat Ne applirant is a resident of IrW'�ana a�
owner I contract buyer of Ne aforeme�rooned property on date appliratlon is filed.
jranue (pwner5 h�me) Date (mon1A, daY. Ya�
0.L i !/�� � % o� O �7.
au4wr¢eC by Etdy exew�etl Power of Attorney w by
persm (numOer antl svee4 �/�Y, sbte, eM LP rode)
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