HomeMy WebLinkAboutMortgage_Willis"'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �
FOR DEDUCTION FROM ASSESSED VALUATION
� State Fo�m 93709 (R71 / 6-09)
pr¢soibed by DepaRmen� of Local Govemment Fnance
e a
INSTRUCTIONS: ��ip �th�
To be filed in person or by mail with the CounryAUditor or Counry Recorder of the counry where the propeRy is located. � Cp � J L��3
Filirg Dates: 1) Real Pmperty: Must file dunng the yrear /or which the deduction is sought. � County Audilor
2) Mo6Ae / Manufactured Hwnes not assessed as Real Property: Must file dunng the twelve (72) months
before March 31 of each year the deduction is sought. � ef
See 2verse side foraddiGonal instruUions and � rtACnu �ni iuTV ei �nirno
�,��°'�.°`�'� `
i
arreld
If ro. what is fus I her erarl share Of inteirsi?
If rart�e m mmrd is 61fe2nt than Nat of appl
�J(O'
�. / fAnUaG L
Wrtent year
cmtrad seLer (nuriibrJ and s�4 �y. sbte.
Name of asvyiee w other owner or haider of mortgag/e�{/�✓/!
�/ K�C.
Add�ess of assignee (number aM stree; dry, stete, antl LP mOe)
Does appli2nt own property in any oUer If yes, xh
amwnt at
'QQ��7
ss unpaid as U Mart
��
If owne0 with �,
:d�AI:��7_l�lY]YLL'i
ptedness unpaid as d Is Ne appOcani ttrc sde
�) iegal of eWilaNe awrre(1
�V ❑ Yes ❑ No
spouse. ind'rcate wtth whom
IS WOPQnYIfIQ11C5UIX1:Mf41dMAS52S5CC
Real ProPe�A' ❑ ��N �
Mohile Fiome !IC G1.1-i
Has ihis tletlutlirn Deen requesteE m propeny
far artent year? ❑ Yes ❑ No
2� 2� 2� _ 20 _ 2�
Sig�Me W Coimry AW itw Counry
I I We certrfy under the penalry of perjury tliat the aDOVe and (oregoing infortnation is We and corteU and th�
�owner I mntrad buyer of the afwemerrtioned property on date applicatlon is filed.
� Sig re (ovme/s fiA ) ` � `
� FWI �esident aGNess o! appGrarit (number artl sLee4 �: �te, antl ZIP mtle)
I��lb5 V•J .} `��0 Sow� tnS � 1�C I� �-�'�1� b5
Psson autho�aeE Dy Ouy �ecuted Pwer o(Aliamey or IC 67.1-12-0.7
Pddress of autharrzed persai (n�mberantl svee; tlry, state, antl LP cade) .
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