HomeMy WebLinkAboutMortgage_Williams (21) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709(R11/6-09) ��''""''11
Prescribed by Department of Local Government Finance I�j ip i,f
INSTRUCTIONS: Yg '
To be filed in person or mail with the Court Auditor or County Recorder of the county where the properly Form filed with:
Pe by County h y P Pent is located. 1
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. MA 1 !It'll
unty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ •only Recorder
See reve/-side for additional instructions and qualifications. i/�11�
AppGray(. wconvay buyer-see resuirmnswreverse side) � GI$SON COUIIY AUDI IUK
■
(A elt T. :`,fv' ,•.• number/legal descrip. Record number Page number
, 2.G. - i ..07 - 303 - cc 1, ,57 - 0 )- g 9.o (2. a.33J
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Martin 1,conent year March 1,current T date of aPPr¢abon legal or equitable owner?
4O (' 0V ❑ Yes 0 N
It no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is dtiTenant than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ^ n -r ,
Address of mortgagee or contract seller(number and street ci y,state.and ZIP code)//, L_(.�~L/-
—_________.
Name of assignee or other owner or holder of mortgage
Drawer N rO�/�
Address 9_;• street/c�,state.and ZIP code) O•••ao►a{i....... -
7A/ we
Does applicant own property in any other If yes,what county? - What Taring D'N Card No X133/
county in Indiana? El —
'(�Yes No /yam,
COUNTY AUDITOR _
Deduction approved'in the amount of
20_ 20 20 20 20_ 20 20
Signature County ALSimr ` County Data(month,day,year)
4111A-A?
I/We certify under N penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(ownerS/u6 name) Date(monde day,year)
Full resident add of appfcant(number and street ary,[s��,and ZIP code)
(y 0/ � . rnof/tec Sr /-r i"cc ion r ii £7(x 70
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number end sheet city,state,end ZIP code) •