HomeMy WebLinkAboutMortgage_Williams (14)^�� STATEMENT OF MORTGAGE OR
_ • FOR DEDUCTION FROM ASSES�
' �• State Form 43709 (R71 / 6-09)
�' � PresmLed q' DePa�ent af Loral Govemment Frianu.
JAN 14 cuia
INSTRUCTIONS:
To be h7ed in person or by mad wifh the CounlyAUdito� or Counry Recorder o/ the vdie t�is located.
Fifirg Dates: 1) Real Property: Must file dumg the year Por which the deduclion i
2J Mobde / Manulactured Homes /rot assessed as Real Pro�e� �' �j�j�nonths
6efore March 31 of each year the deduction is saght.
See 2verse side for addrtional instructbns and qua/fications. /� �
MP���(ox+cer bN'er-see on�vers� ) .-. _ /1 . . II . � n
�ed vahie of real pop�ty a5 of
arM 1, omertl yPaf
no. xfiaf Is his / her eXac1 share Of inle2st?
name m recad s d�Rem�t Uan Nat af app!
� File Mark
Fortn f�ed with:
��unry Auditor
❑ County Recorder
�/ Con�teanrss unpaid as of Mwigage I Con�C i�ebiedness unpaid as o1 Is Ne a�
cumnt Eate of aOP�� legal w
�
tt awned wiN someane athrl ihan sPO�. trdkate wtth wtwm
6ebw. Is ihe praprlty in Queslim: Annw
❑ Real Property ❑ nrmual
hbb0e
��a�����„��� . � .�y �
• - �n.. s+a'e.. aM LP mde—`
Add2a of mornJa9ee w o � � ,,, "'_' )
�� `.�-� �M�, S ..S (�k !� S � - -
rJame ut assignee or ome�
Adtlress of assignee (nun � � � `/ �
Does apP�nc wm p(op /_ % � / � � /
munry in Ind'¢na? P
tlre artmunt o;:
Zb _ � 20 _ � 20 _ � 20
x�
f:
artent yeaR
20 _ � 20 _
,�•�� �
rant the sole
�Itahle ownM
Yes ❑ No
�equrste0 an P�Y
n Ves ❑ No
20
�� ry�/ l l lil � �nry -�/1 A Al�G�'� I Date (imiCh. deY.Yea�
I I We certify under the penatty of perjury that ihe a6ove aM foregoing infortnatlon is true and correci arW Nat the applicant is a resident of Indiana aM
r I mntracl buyer of the afofementioned pro date applintion is filed.
naw�e o fu0 re � � Date (monfh. daY. l'ee�
en a�f�ant�beranEyna�,a,•°•'� n"d'�/1���/ .\C��i� �.'
1 (
by Oldy exenrted Power o(AttOmeY w by IC 61.1-12-0.7 I��a (�W. �Y•
Pd person (num6er and snce; city, sfate, eM LP code) .
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