HomeMy WebLinkAboutMortgage_Williamson"'+,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownshi Year �
• FOR DEDUCTION FROM ASSESSED VALUATION
.• Sfate Fwm 43709 (R71 / 609)
,S � pr¢svfbed by Department af Lncal Govemment F�nce
File Mark
INSTRUCTIONS:
To be fi(ed in person a by mad wrth the CowrtyAuditw or Counry Remrder o/ fhe county where the property is Ippted, NO F t� .
Fifirg Dates: 1) Real PmpeRy: Must file dunng Ne year (o� which fha deduction is sought. n,�
2J Mo6de /ManWactumd Homes rrot assessed as Real Properfy. Must fi1e dunng the M1vefve (12) months C�� unry Auditw
before March 31 of each year the deductnon is saghG - � ty Remder
Seereversesidefor�7fionalinshuclionsarMqualifications. , GIBSON
AGPfrenl (owireror buyer- s� m�r�p� on ptrar5f sitle) .I� / � /� n _
Tawg
wsrssm vanre ot � p(aperry az
Alarth 1. ac�art year
tt ro, what is his! her e�2 share ot
7 �q M�oIrtdpag'e/00 �DO(. gg S -Oa25
Mardi 1, / Contrac[ IndehteErress unP� a of Morigage / Cantra
exj�ifw�.� \ date of apP�'ation
If name on remnd's dMemnt Nan Nat ot app6cant bd'uate
Name oi mortgagee w contract seller
AddRSS of rrortgagce w mntract seller (nuniberend sb
Name of assi9nee or other owner or hdder of mortgage
Addmss of assgtree (nvmberard street Nry, stafe, entl
Dces aPpfimnt wm pmperty in any oNu
munty m Intlaru?
❑ Yes ❑ No
Dr�uram apprmv.W i� tlre amount af:
20 20
SigreMe of CoimN Autlitor
I/ We certNy under Ue
Person authoraetl by
if awned wi� someone
LPa ����.lj Pr�� r
,,,�. FQ.y� D
20
RemN num6er Page numbu
6tedness wpaid as W Is ihe aPP�+t the sole
legal w equitaNe ameYl
❑ Yes ❑ No
spouse, IMimte witl� whom
Is the Droperty in Questlon: Mnualty PssesseG
❑ RPai a�oaenv ❑ amuany w�ssea
Mohle Fbme (IC 61.
�a dedu�im Eeen rc9ueste0 m O�Pe+�Y
uremY�� r� .. r--i .
l�t - 3 7 8(�
20 20 20 20
Cwnl�' DatB (/nonlh. 08Y. lEa�
that the above and foreguing infortnalion is W e and comeU and Nat Ne applirant is a resident of Indiana antl
ned pmperty on date applintlon is filed.
Pwmr af AitameY ot by IC G7.1-12-0.7
otau�horae0 persm (numberantl sbeet tiry, state, eM
Date (monN. tlaY. YE?�— _ .