HomeMy WebLinkAboutMortgage_Weaver (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ • FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (R71 / 6-09)
�` y�� > presrnbed by Oepartmen� of Lod Govemment Fraixx
F
wsrnucnoNS:
To be Red in rson or b mad with Ne AWitor or Coun Recorder o/ fhe ooun where the ro D Fortn m'end wi�:
pe Y ���h' �Y �Y P Pe+ryabcate�ED �[y��
Frfig Dates: 1) Real Property: Must file durirg the yrear fir which the deduction is sought. � unty Audtor
2J MobBe /Manufactured Homes irot assessed as Real Property: Must file during [he hvelve (12) rtwnths �
before March 31 of each year [he deduciion is sought. - Coun Recorder
See reverse side for addiUOnal instrucUons arid qualifications.
MP��� (ox+repo[yQntraC 6uyg[.�see qi reverse sile)
an
Key rvanber / kgal desaiPtim
a ` _ ► I- �.s- inn _
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dfiemnt ttan that o( app6mni, trd'aate Dekw.
Name N mortgagee or contracc se9er /7 �
V
Address of rtwrt9a9ee or contrad seller (num6er aM s4ee4 clry, sfafi, aM:
Name of assignee w other ovmer ar tmlder of mwt�age
AqC�ass of asa9nee (numbr.r ard s(reeL �y: state, and LP ootle)
Oces eppiimnl wm property in any oNer tl yes. what count�(.+
�w�h io ��d'ar�a�
❑ Yes ❑ No
Orduction
29 _
SgreMe W Coiu
I I W0Cef4N
20 I 20
2
nder Ne penalry of perjury that Ihe above and foregoinc
ct buyer ot ihe aforementimed pmperty on date appfi�
h� nama)
Person authoraetl by duy �ecu[ed Power of Attaney ar by IC G7.1-12-0.7
ldtlress a/ authorar� person (numbarand snee4 mY, sbte, end LP code)
a�m ��e,�
date of appOwtion
(Y1c�n,�.- t��.��V
��� C�
,���3�16�.�
a,01�- I�(�
w equita6le owneYl
❑ Yes ❑ No
alyascsu0
P��Y
❑ No
20
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