HomeMy WebLinkAboutMortgage_Williamson (6) STATEMENT OF MORTGAGE OR CONTRA i TE S County Township Year
FOR DEDUCTION FROM ASSESSED VALU qpl 1
t` i! State Form 43709(R11/6-09) g••
'`?:. Prescribed by Department of Local Govemment Finance
File Mark
INSTRUCTIONS: JUL 3 2013
To be filed in person or mail with the Court Auditor or County Recorder of the county where the property Form filed with:
Pe by h ic h P Pam is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is ht
2)Mobile/Manufactured Homes not assessed as Real Property:Ma ( elve 02)months County Auditor
before March 31 of each year the deduction is sought G(BSON COUNTY AUDITOR County Recorder
See reverse r additional instructions and qualifications. / ) ,L� ///�,/
Appfuan • � •-.;vyer,eje on reverse side) 1,,,b,,/1Jl' ' - ' _ "�
Taring (�(��-Key num /legal descrip" ` Record number Page number
� LQirc ` .b-►8-f3 -40a -oc0•G-7'-c, x013 0235 /
Assessed value of real property as of Mortgage/Contract indebtedness ii rid• as of Mortgage/Contract Indebtedness unpaid as of Is the apptcant the sole
Math 1,ctsmit year March 1,wrtent{yeal ,r�� ] ) date of appGntion or de owner?
l/Sri!`/(/_ ,/ ewca
❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile
Name of mortgagee or contract seller
Mobile Homo(IC 6-1.1-7)
Address of mortgagee or contract seller uuu iw....-' •- - - ---- _ ---
Name of assigr
Address of asst
Does applicant i ction been requested on property
county in Indian. 3rr
I ❑ Yes ❑ No
Dedumon apprd C v
1 en 2° /�
' 20
VA r (i^_)
Signature of / (month,day,Jeer)
•
I/Wecertify Q )(1 nt is a resident of Indiana and
owner/contr. �• 1 0.
Signature(otmed. Date(month,day,Year)
• v
__. authorized by duly- -. .ed'• - of-•• - or by 6'1-12-0. Date(month,day,year)
Address of authorized person (number and sweet dry state,and ZIP code)