HomeMy WebLinkAboutRay, John and Patricia - 16-10-29-01-01-05-034.000Office of the
Clerk - Treasurer
August 12, 2011
City of Carmel
Hamilton County Recorder
33 N 9th St Suite 309
Noblesville IN 46060
LIEN RELEASE
2011039644 RELEASE $12.00
08/17/2011 01:42:12P 1 PGS
Mary L. Clark
HAMILTON County Recorder IN
Recorded as Presented
111111111111111111110111011111011111111 !1111IIIII Hill IIIII IIII1111
The following lien for Barrett Law assessment recorded in 2001 for the Cool Creek North Subdivision,
Instrument #200200085679, against the property listed herein opposite their name, of the City of
Carmel, having been paid and discharged, such lien is hereby declared fully paid, satisfied and released
this date.
Name: John & Patricia Ray
Address: 47 Ironwood Ct Carmel Indiana 46033
Total Paid: $781.35
Parcel # 16- 10- 29- 01 -05- 034.000
This instrument prepared by Jean A. Belcher, Deputy Clerk Treasurer
rat i { i'! /' ' .,.
Diana L Cord ray,,,Cler.,k Treasurer
City of Carmel, Indiana
, • I affirm, under the penalties for perjury, that I have
r ; I .)' taken rea . . • e care to redact each Social Security
numbe ! . document, ;1 ; ss required by law."
/'9 •
I
(name)
' ONE CIVIC SQUARE CARMEL, INDIANA 46032 317/571 -2414
Office of the
Clerk- Treasurer
August 12, 2011
City of C
Hamilton County Recorder
33 N 9th St Suite 309
Noblesville IN 46060
LIEN RELEASE
c�l
1
2011039644 RELEASE $12.00
08/17/2011 01:42:12P 1 PGS
Mary L. Clark
HAMILTON County Recorder IN
Recorded as Presented
11111111111111111111111111111111111311111111111111111111111111
The following lien for Barrett Law assessment recorded in 2001 for the Cool Creek North Subdivision,
Instrument #200200085679, against the property listed herein opposite their name, of the City of
Carmel, having been paid and discharged, such lien is hereby declared fully paid, satisfied and released
this date.
Name: John & Patricia Ray
Address: 47 Ironwood Ct Carmel Indiana 46033
Total Paid: $781.35
Parcel # 16- 10- 29- 01 -05- 034.000
This instrument prepared by Jean A. Belcher, Deputy Clerk Treasurer
Diana L Cordray, Clerk Treasurer
City of Carmel, Indiana
" ONE CIVIC SQUARE CARMEL, INDIANA 46032 317/571 -2414
r
wl_:
CITY OF CARMEL
BARRETT LAW DIVISION
10/08/2008
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
rv�s Obi b aFF
oA) 4
INVOICE
Cool Creek North Annual Installment 581.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood The next annual payment is due by 11/10/2008. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2008. You may at any time pay the
entire balance.
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
t
2008000744 BARRETTLAW $13.00
01/07/2008 11:01:29A 1 PGS
Jennifer J Hayden
HAMILTON County Recorder IN
Recorded as Presented
CITY OF CARMEL
BARRETT LAW DIVISION
01/07/2008
Hamilton County Treasure's Office/Hamilton County Recorder's Office
On 11/12/2002, the City of Carmel recorded instrument number 200200085679 for a delinquent Barrett
Law Assessment. The following delinquency has been paid in full and we request the removal of said lien.
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
Parcel: 16- 10- 29- 01 -05- 034.000
Instrument Number: 200200085679
Legal Description: Cool Creek North
Please contact me at 317 -571 -2427 if you have any questions. I have enclosed a self addressed stamped
envelope for the release to be sent back to me.
Sincerely,
Karen Huffman
This instrument prepared by Diana L. Cordray, City of Carmel
Diana•L. Cordta+y, .� le c -Trea rer
Cite i armel ' ..
ONE Cr, >'�, eARE CARMEL, INDIANA 4603
"I affirm, under the penalties for perjury, that I
have taken reasonable care to redact each
Social Security number in this document, unless
required by law."
/,y Karen Huffman
(317) 571 -2427
. >s
2008000744 BARRETTLAW $13.00
01/07/2008 11:01:29A 1 PGS
Jennifer J Hayden
HAMILTON County Recorder IN
Recorded as Presented
CITY OF CARMEL
BARRETT LAW DIVISION
01/07/2008
Hamilton County Treasure's Office/Hamilton County Recorder's Office
On 11/12/2002, the City of Carmel recorded instrument number 200200085679 for a delinquent Barrett
Law Assessment. The following delinquency has been paid in full and we request the removal of said lien.
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
Parcel: 16- 10- 29- 01 -05- 034.000
Instrument Number: 200200085679
Legal Description: Cool Creek North
Please contact me at 317 -571 -2427 if you have any questions. I have enclosed a self addressed stamped
envelope for the release to be sent back to me.
Sincerely,
Karen Huffman
This instrument prepared by Diana L. Cordray, City of Carmel
"1 affirm, under the penalties for perjury, that I
have taken reasonable care to redact each
Social Security number in this document, unless
required by law."
Karen Huffman
Diana L. Cordray, 'Ierk -Trea
Cit-lo Carmel
ONE CWitSQIARE
CARMEL, INDIANA 4603
(317) 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISION
11/29/2007
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16-10-29-01-05-034.000
Dear: John & Patricia Ray
INVOICE
Payoff of Cool Creek North Barrett Law Assessment $211.69
The payoff is due by 12/29/2007. Please make the check payble to the City of Carmel Barrett Law
Division and send to One Civic Square, Carmel, Indiana 46032. Please send the enclosed
REMITTANCE COPY with your check.
ONE CIVIC SQUARE CARMEL, INDIANA 46032
Karen Huffman (317) 571-2427
( ((Lt3(LUV( ZV:44 rnn J1(0112480 PAYROLL
CITY OF CARMEL
BARRETT LAW DIVISION
11/29/2007
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel 1: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
RI 002/002
INVOICE
Payoff of Cool Creek North Barrett Law Assessment S211.69
The payoff is due by 12129 /2007. Please make the check payble to the City of Carmel Barrett Law
Division and send to One Civic Square, Carmel, Indiana 46032. Please send the enclosed
REMITTANCE COPY with your check.
REMITTANCH; COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
11/29/2007 THU 08:47 [TXIRX Nn 52R41 finn2
I itztuLVV ( LV:44 rlift i] (b f 12480
11/29/2007
PAYROLL
t.
CITY OF CARMEL
BARRETT LAW DIVISION
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
Ii002 /002
INVOICE
Payoff of Cool Creek North Barrett Law Assessment S211.69
The payoff is due by 12/29/2007. Please make the check payble to the City of Carmel Barrett Law
Division and send to One Civic Square, Carmel, Indiana 46032. Please send the enclosed
,,,...,,a;�:a�;.��aise�?aCr
MADISON rI1 tE6ACco IATE
yes a•CLQSING` .
rtR.� rr''i�..+�.:�++M1�y�w er..W.wwrTC. �. �,4 •..- yL' ^.�r`F!.•'�!'a5
IND ANAP2LIS jN 4 2Z6.:.:?
�� �u.:i;"�' »"..' # {s
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�2Q7404/2740'9'
*MO= P.,*
DOLLAR
RECEIPT
Fu'd: =' " 220 Barrett Law Fund CITY OF CARMEL 01/04/2008
OFFICE OF CLERK - TREASURER
Total: $211.69
For the Sum Of: Two Hundred Eleven Dollars And Sixty Nine Cents
Received from: madison title /mail /ray
On Account of: pay off /cool creek north
Payment Type: Check
Remitter Signature
Authorized Signature
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR THE CITY OF CARMEL - 1989
24309
CITY OF CARMEL
BARRETT LAW DIVISION
10/17/2007
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment
$81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett T. ,•■rs;o
to - _ _1 mi-
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Fund:
RECEIPT
22:u-E-) Law Fund CITY OF CARMEL
OFFICE OF CLERK - TREASURER
Total: $81.38
For the Sum Of: Eighty One Dollars And Thirty Eight Cents
Received from: ray /mail
On Account of: barrett law /cool creek n
Payment Type: Check
Remitter Signature
Authorized Signature
u9iAL% .41.0.
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR THE CITY OF CARMEL - 1989
10/26/2007
24085
0
CITY OF CARMEL
BARRETT LAW DIVISION
10/17/2007
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood.The next annual payment is due by 11/10/2007. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2007. You may at any time pay the
entire balance.
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISION
10/17/2007
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood.The next annual payment is due by 11/10/2007. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2007. You may at any time pay the
entire balance.
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISION
10/18/2006
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the le Barrctt Law project
in your neighborhood. The next annual payment is due by 11/10/2006. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2006. You may at any time pay the
entire balance.
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
I
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11'0081 1 2 ' I ' 1:2 7 40 7 40 401® 08000 2 1 3609Ili"
10/18/2006
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01- 05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records shove that you have agzeed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11110/2006. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send'the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2006. You may at any time pay the
entire balance:
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
Fund:
Total: $81.38
RECEIPT
CITY OF CARMEL
220 Barrett Law Fund OFFICE OF CLERK - TREASURER
For the Sum Of: Eighty One Dollars And Thirty Eight Cents
Received from: ray /mail
On Account of: Barrett law /cool creek n
Payment Type: Check
Remitter Signature
Authorized Signature
10/27/2006
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR THE CITY OF CARMEL - 1989
2273.2
CITY OF CARMEL
BARRETT LAW DIVISION
10/04/2005
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11/10/2005. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2005. You may at any time pay the
entire balance.
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISION
10/04/2005
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11/10/2005. Please make the check payble
to the City of Cannel Barrett Law Division and send to Once Civic Square, Cannel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2005. You may at any time pay the
entire balance.
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISION
10/04/2005
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
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Fund:
RECEIPT
220 Barrett Law Fund CITY OF CARMEL
OFFICE OF CLERK - TREASURER
Total:''' $81.38
For the Sum Of: Eighty One Dollars And Thirty Eight Cents
Received from: ray /mail
On Account of: barrett law /mail
Payment Type: Check
Remitter Signature
Authorized Signature
10/18/2005
FORM APPROVED BY STATE BOARD OF ACCOUNTS FOR THE CITY OF CARMEL - 1989
21401
CITY OF CARMEL
BARRETT LAW DIVISION
10/05/2004
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11/10/2004. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
hlnI I5I I1I' II ' , u I l I
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RECEIPT
Fund: ' 220 Barrett Law Fund CITY OF CARMEL
OFFICE OF CLERK - TREASURER
Total: $81.38
For the Sum Of: Eighty One Dollars And Thirty Eight Cents
Received from: ray /mail
On Account of: barrett law /cool creek
Payment Type: Check
Remitter Signature
Authorized Signature
020221
11/10/2004
FORM ' .? u BY STATE BOARD OF ACCOUNTS FOR THE CITY OF CARMEL - 1989
CITY OF CARMEL
BARRETT LAW DIVISION
10/05/2004
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16-10-29-01-05-034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11/10/2004. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2004. You may at any time pay the
entire balance.
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571-2427
CITY OF CARMEL
BARRETT LAW DIVISION
10/05/2004
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11/10/2004. Please make the check payble
to the City of Carmel Barrett Law Division and send to Once Civic Square, Carmel, Indiana 46032.
Please send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2004. You may at any time pay the
entire balance.
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISION
09/25/2003
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID:
parcel #: 16- 10 -29- 01-05-034.000
Dear: John & Patricia Ray
53
INVOICE .... .. ..... ......81.38
Cool Creek North Annual Installment..... • • . • • • ' ' ' ' ' ' ..
to make 10 annual installments for the Barrett Law project
— ^ ` -`"A2 _ Please make the check payble
111 ncP.
Ti: ORIGINAL'` CHECK HAS∎A'COLORED BACKGROUND ,PRINTED'ONtCHEMICALHREACTIVE? PAPER - :=Y SEE; BACK FOR AILS
',DET :
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ARMEL;',1NDlANA:46433
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11'00 ?4 290 I : 2 740 740401: 08000 2 1 3 60 9 70
0
CITY OF CARMEL
BARRETT LAW DIVISION
09/25/2003
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
0 Dear: John & Patricia Ray
0
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11/10/2003. Please make the check payble
to the City of Carmel Barrett Law Division and send to One Civic Square, Carmel, Indiana 46032. Please
send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2003. You may at any time pay the
entire balance.
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISION
09/25/2003
John & Patricia Ray
47 Ironwood Court
Carmel, IN 46033
ID: 53
Parcel #: 16- 10- 29- 01 -05- 034.000
Dear: John & Patricia Ray
INVOICE
Cool Creek North Annual Installment $81.38
The City's records show that you have agreed to make 10 annual installments for the Barrett Law project
in your neighborhood. The next annual payment is due by 11/10/2003. Please make the check payble
to the City of Carmel Barrett Law Division and send to One Civic Square, Carmel, Indiana 46032. Please
send the enclosed REMITTANCE COPY with your check.
To avoid a penalty, you must send your payment no later than 11/10/2003. You may at any time pay the
entire balance.
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 Karen Huffman (317) 571 -2427
• - o C _ o f ' 0 •' .. s . e
alllii�ll���Ilrlll .Illcvgiglll,�yl�'r'`'III �Iu:��w:����l .IImIIm�lIIllI�Iliill� r�
hilIk
Loll
mina
I lliliiviilll w Y ilUCllll!Vif ei! ll!iC i
1 1 1 0 0 2 2 7 0 ': 2 71,0 7 40 40': 08000 2 L 360 9 711'
x Patricia Ray
wood Court
;I, Indiana 46033
5- 10- 29- 01 -05- 034.000
John & Patricia Ray,
I N V O I C E
HORIZEDSIGNATO
hlA �l; - IlllilgnplllllliP
I:u,lvm:,lflll >; IG ' Il
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;reek North Light Project 2nd Payment $81.38
/15/01 you paid the amount of $81.38 and agreed to the10 year payment option for the
t Law Assessment in Cool Creek North. The 2 "d annual payment is due by November 10,
Please make the check payable to The pity of Carmel Barrett Law Division and send to
;ivic Square, Carmel, Indiana 46032. Please send the enclosed yellow remittance copy with
;heck.
REMITTANCE COPY
CIVIC SQUARE
CARMEL, INDIANA 46032 317 - 571 -2427
CITY OF CARMEL
BARRETT LAW DIVISON
October 7, 2002
John & Patricia Ray
47 Ironwood Court
Carmel, Indiana 46033
Re: 16- 10- 29- 01 -05- 034.000
Dear John & Patricia Ray,
I N V O I C E
Cool Creek North Light Project 2nd Payment $81.38
On 11/15/01 you paid the amount of $81.38 and agreed to the10 year payment option for the
Barrett Law Assessment in Cool Creek North. The 2nd annual payment is due by November 10,
2002. Please make the check payable to The City of Carmel Barrett Law Division and send! to
One Civic Square, Carmel, Indiana 46032. Please send the enclosed yellow remittance copy with
your check.
REMITTANCE COPY
ONE CIVIC SQUARE
CARMEL, INDIANA 46032 317 - 571 -2427
Barrett Number: CCN -001
Resolution Number: BPW 06- 06 -01 -01
Property ID: 16- 10- 29- 01 -05- 034.000
Barrett Law Installment Schedule
Year
Principal
Interest
Total
Payment
Due Date
1
43.36
38.03
81.38
11/10/2001
2
46.17
35.21
81.38
11/10/2002
3
49.17
32.21
81.38
11/10/2003
4
52.37
29.01
81.38
11/10/2004
5
55.77
25.61
81.38
11/10/2005
6
59.40
21.98
81.38
11/10/2006
7
63.26
18.12
81.38
11/10/2007
8
67.37
14.01
81.38
11/10/2008
9
71.75
9.63
81.38
11/10/2009
10
76.37
4.96
81.33
11/10/2010
Make checks payable to: City of Carmel Barrett Fund.
WAIVER OF PROPERTY OWNER
If you wish to make 10 annual installment payments, one -tenth of the assessment plus interest to
the annual due date will be charged (see chart above). If this is your choice, please sign the
'waiver" , notarize sig :t res -nd return in the enclosed self addressed envelope with the first
payment.
Signature:
Signature:
oft/ 4y
Installment notices to be mailed to: 'y % / ROj✓ � �� T
C/-g � Vag JJ
Subscribed and sworn before me this 174764 day of /oves4Ief 20 0 /
,4 lrek✓ Ire /9U so r\
PRINTED NAME OF NOTARY
AY m' -/4,
COUNTY OF RESIDENCE
NOTARY'S SIGNATURE
4
My Commission Expires e o?‘/ �/ .200 9
�
M ANDREW FERGUSON
NOTARY PUBLIC STATE OF INDIANA
HAMILTON COUNTY
MY COMMISSION EXP JUNE 26,2009
ID
DIANA FEDERAL
CREDIT'UNION
JDIANAPOLIS IN
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