HomeMy WebLinkAboutMortgage_Williams (2)^'�v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year �
_ � FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fom 43709 (R11 / 6-09)
�` � i p�¢�'bed by Departmerd af Local Govemrtrenl F�w¢e
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lNSTRUCTIONS: e wpEl1
To 6e filed in person w by maii with the CounyAuditor or Counry Recorder of the county where the property is located. ��J� Lu 1
F�fig Dates: 1) Real P�opertY. Must fife durirg the year /or which the deduction is sought � County Audimr
2) Mobde /Manu(actured Homes rrot assessed as Real Property: Must file dunng the twelve (12J months
6efore Ma`ch 31 of each year the deduction is sought. e��
SeereversesideforadditionalinstnictbnsarMqu2lifications. n � �.��c.nu rn��M7V Al1DITOR
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MafU 1. amnR year
n no, vmat Is nis � ner exae d,a`e or inieresc?
tl nartre m femrd I5 Gdfermt than Nat ot appfran� u�tlicate 6elow.
nwryagee ar mritract
Nama af assi�ce or athei wmer w hdder at mortgage
c�. an
street, dry, state, and LP cotle)
ryoperty in erry oNer I II yes, wha[ count�?
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unpaia as or ��wigage � con:�aa mjap�9dm
someone
� / ' �/
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�of Is ihe eppGrant tha sde
legal w equitahle mmeYl
❑ Yes ❑ No
with whom
pelty in Question: Mnua%ASSessed
Pmperty ❑Am1ua11yAssesSed
Ta.dtg D'atricl? Has ihiv tleduflim been requested m properry
for artenf yeaR ❑ Yes ❑ No
• ° COUNTYAUDROR
Dra���cr \i0.....��
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� 1 3CD C9. . . . . . 2� 20 _ 2� _ 2� _
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C� I' Ci � •�• �/ ��iY oate (monm. dar, i�aA
p � I Ct�t. �
I I We certfy under ihe penaliy of perjury that Ne above and foregoing infortnatlon is We and corteG arM that the applipnt is a resident of Ind�ana ard
ovmer I contracl buyer of the atorementloned property on date appliration is filed.
`� ��m¢v��owner:
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� Rel re�dem aaar�
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Pe�sm autho�¢M
state,
person (num0erantls�ee(clfy,5fat&aMLPOOtle) .
Date (rtmM, day, yee�
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