HomeMy WebLinkAbout26888 ASSESI5OR'S' COPY `' PLEASEFILL Q 1 III :?;:,10t1:1110Ah
�1 MPLETELY
u1111 uuull 1u11119111X IIW,
1 REAL STAIIII �E II,EXCISE.I'ITIAIII -- II�Iq
IIII �.��
MAKE REMITTANCE PAYABLE Td JIEFFERSON CCOUNTYITREASU EIR
XXpp����XXL II �#• ';:',11!'.!11!'111,.'
._ 777 :. __ III _x . .- ,.„11�N uli l+ �� 1;n �k:�_..::. ;y^� .IIIA 7777 +_._...` +1, L-N4Wr . 7,777. ,.._,_: ....,w,.Vllllil„ 111111,'"
h1AMEl :IN ,.'.'• �� r I�dl - I NAME OF-_SELLEF'AM GO'MP„L'ETE ADDRE-S5' 1 ul,'"y I" ,7.77.7
ADD1tle1551 II IBIIIIIIIIh II it s-. _r' 1111111 .-7,I�I'I7. 11, a.� , 1. '.,'...''. !VIfII.
7.";""7.7:7777:17
,. � u N I Xw h u u II
- - Xk., 1 III II ani:” ,u . •u I7777.
NAME �y 111 �---�' '"1"n �` a ^,,;>i� # III"11II�II",Il.. :1.!!i.,.1;:.,',,:.';''..:1111:1,11111111,::.'•:''': IIIIIIIIIIIIIV:11,VuIIIJIII • i I IIII '", :!,;:,,..1,11:;,::!:110:!';:..L.'.:..:''. --:?,-:_-7f.,11.::!'..,-_.l
. _;"7.7. :. _ ---f' - II�r + ..L J� .__r, _ ^-, ,-" _•_p ___,I__ __ --.-._ '_u___�' +u I. -
h. ,:. CpM,PL1 ETERr -.';.
ADDRESS III+,VIII fid 1X1'1 o::rll llullaXlu 1 i61u111 -�: II 1 w .NAME OF,BY�R AND,1�, ,� a;Ir, .1,14111111t!..' '°"` ', 'I
II until G'^.�,� :,.",:'I,,. ull'1141"':':N° I"" '^..' Vvl 1 r = ,."I-, iN I:'I I' III e Vill 6"IIVI'> _•_-- +,`:,• �i";'I IM IV Iy = V VIpp: II
h1, r �" ;: , .,: .____._.: !111.9INXIhINIIw16NINIIV1111IXII Ip 3 II9IIIII'7......:,: ,'.. , :0 - ,
Legal description;of r''Illll pl opertylilSituated in11,rEEp�ERSOtt COri,N y 1 91NI3
�,,,.. _ y" . ...:�.^ IIII IIII jIIIIIII1.1L1i liliI ._ ___Z—, VII IIiN I I� .,,•,,,,!,!•..:,„:,:!„:,,,...,,• v.,:,:.w..._�Tm VI VIIII ...�.....;... IIII :___
•
•
I I — _— I I VI II '•IIII 1
1 1111 11:11 1
II III 7777_- , ',., , __._. • --"•:,.:,'.!::•.1:!!i.•,•
.�� - --_' IL I!I�II
._•!:•1':'''''',-,-!'-','':',,::„. - 7777, - 1; -
- -7777 ----7`777 I1, - - - - 1
-- 77'77---7777-- - I 1 � ' '�
- -- --7777_, I, .
::,,:,'...•::!,,,:,,.....H.:'. - --- -` 1, '1'I 1 ,�, 1111 -_,- il.
- , — -- '- '- I III -777._ ,111
_. 7 „-_ I �, _ u �
_ .-.-!-_,=_-__ II .7777-. 1.I.
m ',
.77 ';.�,� ••,"•',1,,,i,,••'' 'I I _ ••':':1,',11,•:•,',,,,::', -. __ _-.- ,.1 I I„
:,:„..1,1„„,!,1,1111,,,,,,„..:: .:. �d r• 1I111,11!III111 I I � I I
' --- I IIII 1 ,;��;r;,
SALES • • II
HArjDLED •
rll',,
BIS ,", • l
I ••••
•
GROSS.SA::!;!:EPRICE Y 1'iu'011 X111.11�I;'',i-1,- 4N ua t; „ •• t"kA 1 u.'
I la.:
.. '.�>- �^EXI1�uuu1NIX1 �Nlllhu�"'yGllllll�� ����i,�ww —.E:Shcllw �ril=';� _ .,,.,,.;:. .,,,.�.+ III II�w-iliEXtiq,T11X� '(: IIIIIV „" - . .;,', Iltlluul�IllllVuil"� .•, :_ -111pllll
II n �. VIII III IIII�_.
FVIII III I1P -'n 11
$ hna III !"*010th.aft_a 30 ) I.1 .."':...:.'1..''::::,!!.!!!11111111:!:..'.I,.
PERSONAL PROPERTY - (Dwirct) hp (1�►pr •
1° III
TAXAILE SALES PRICE : (enli of ieliwry d inclreaEeaf ff flwt � r l-ltiul!Vi.- TOTAL'1 +-_-•-'Vu,Tll''11X1"
DATE OF INSTRU MT, x+111 s "1 xl c rl
is clea9iaf� pi is , �
3Ndruct,etherwis,IIQNI�1 1 II Plllltll i uV 1p,I II a ':I v
_ „11 II IIII.191'j'i 1:1,1 91111111 1 ' AFFIDAVIT
.
exuuNae of ZeEer I I it, _ " u 1 ;,1117 III 1111�II IIIh11 I ; 1,I IIII I
•).u'111 �1 w", 're"1� Il V 11VpNV IIIVII l IIII 11NG, _ ... :._... The YM�frsi 1 iElE first SWMfp M sad:says that tIN I s
TYPE OF INSTRUMENT-. ,� my NI11 l is a 1rw:rMl urr lelcf shNnwet of the fuh rhi f
Pe +� •the f elEef�r
'111,+._ ' .. .. ' r rll 411T i I llVti1 X I :
If-hX exsEnpfien is dahnad.XPIOIf'fully fhe nalwe of-the transfer I-l---l s ' - ebw��escrR�e�l It Ilellal�I�staMf 111 I,'Iu 111V11
r-_..: 1�'yy IyNIVu111i II y�' 1.,:::::::!,:::,11111411:!:.;;,,:::,;:,:,11:,,.."X1119111luV 11u XI� --: I
- ' "* i,`. ":X .54GNA7UR'i -_
_:'iY.'• � :j1 r 4 '� - 1, 111, — • 1111I11'I
iif sole cs'wrs VIIII V 1 I V 1 „'.1'.,1!1:111,111;111111V!&:!,''':::'
111111111119-XI
I 111 ;: y ':. 1 -147117°"'""..
7777.
pE'eWnY'VltYaiei ISn�Ilier Sutiea Alt 141,1' ” �.. y
•• .• h!Pf°► !i7 Ex.Session,.tare ia7e Any Per • e aM false 1taN* „ IIX11110��1 afKdavit shad he eahyct
d prier sale vif Ne. 1 111111II111I111j 1111.1111 b �rjnry.lews of the State of t - m
Rrfer AfNia
FOR STATE DEPgRTM1ENT'OF REVENUE USE ON:L.Y 1 11hIVXI ,'-- 1111 r1llpiM1Ih1 11i.
11IVVI1 _ lry,.j11111 HII�
i1S cr
1;q9 MV N.
Whs ihei
lz 11
111
LAND--- 1 ani w Lh iafiwraEa •
41 SCHOOL DISTRICT :' V!„1,'1��, : !lil 1 , �11 'rl's�,l��'u ...,
1111 u m � II,�� :r 1 1 V1 � f1, ri11iN��l II I Iu I il„Il lu
"' ,u!I',11 1j1 1�1 III .zj, II 11 I�ul 1111
IMPRgVEMENTIS, :.,.',$ _._ 111111: :,...,..,,,,,•.:1..::,..•.....__' _ 1, III u..7.V I1... "IT I 1
- YEAR• L•AST AP►R - L LI I y l �otiry P"1II11IIk I •llsEe S N9 -' 4��Ji i1 1'll
- .•,,,,,,',.;;,'",!:'"':',:':".• +nip 91 • - h' a .. '.''.''':-.--••,:'777-:-' 1.1 IH 11 9 II III 1�
• 'TOTAL, .:,..,:4',••'': S PROPERfT'•CLASS 1 1 m- a pl �' ,1 'T' ',llu ._.
I 7777. �; „„, "._._�°�III�II�hhII�1v�IL1 :
DO NOT'• . ' -E TH1 SP11 bE
This b,comesl ourl lr",....:".,..„„in!„„::,:--when„--,stamped„,cOFFICE'llSE?QNLY
y , _ pard b'y the county treasurer Payment � 111111X111111X
must bs made l' P cu°Isb of certified check: This return is sdbjAl:t to �Li�#prlf-ariflca--
1 1 uj 11^'111@I--i rrt':',:,, ,-A1„1:110,,:••• Il1' 1 II,I ICll IIl 111 ;I'i'1
tion by the Stoto Department of Revenue�111andX`on incompietplallufidavituprllUI1 be re ..q..„.10,„!1,1,,,,,,,:...
turnod. - Check1111
1 Q”thec'h ,IX
Warn�t recessal Cly,!;
Ink:
._•-7 ..:„: Neta"' Oniy 3 C�is�er+e
T,e,7x7e77it'lattataesd_u
-. 11
11
ilsIll "VIII 1
„p.l
VE�, I
WT NO 1-11.'111 11
I"
AM
OU
T _pATEpA1D i - Vr�_ ll' 1I -After R®urdhg+M— Eix S► co;; lI1 _ � 1 'NII 1 1 II_." IA' mE •" - T� 14 ,I; iX
1cr:I11i1uti _,.... rJIV.1 :1 . l'--.,-;'!". 11,',;,..;:14:;,1#.1
I1^ , "�1✓W+w-- 4 { '....,::.,..,,,;1110141A:1!,:11!'::'1"..:.,....' � I:wts
1,.777T -�. u yl' , . X _ 11X ,;.., ,,, 'h 1 ," :