HomeMy WebLinkAboutMortgage_Georges (2)"•'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION �
. . � State Form 43709 (R71 / 6-09) � �
, w. � Presaibed bY DePartrtie�k ollocal Gwemmerd Frence ��, J
j� File Mark
INSTRUCTIONS: b,
Form I�ed with:
To 6e filed in person or 6y mail with the County Auditor or Counry Rernrder o/ the counry where the pioperty is located.
Fi/ng Dates: 1) Real Property: Must file durirg the year Por which Ihe deduclion is soughL � Counry Auddnr
2) Mo6ile / ManulaUUmd Homes not assessed as Real Pmperty Must file dunng the tweNe (72) months ❑
. 6efore Mamh 31 o/each year the dedudion is mught. Counry Reoordu
See reverse side !or additiunal irtqtructions and qualifiwtions. _
A.Sessetl vah4 dreal P�DatY as N
Ma� 7. ar�elu yw
If rp, what ts ha / hu e� share of interes2?
:31� - 2�d� - 00 /. b' ��
MoRpage / Cantraa We6teOness unpaid az ot
Mard� 7. artent year
on record is dtllerent than that of aDP�•
Pddress of rtartga9ee or contract se9er (n�rtn6e�
Nama W assignee or other owner or holder W morigage
PGtlrass ot sssignce (num6arard atree4 �: s+efe. antl
��
Oraucoon apprwed in tlre amount aE
r
f
city, steta.
� i � i �_
of Co�mb a�tlimr
�
Recortl numDer Page num�
_ aa � �j��
Mortgage / Contract iMebteMrss impaid as d Is the epp0ont Ne sob
date of ep kgal a equRatle ownell
��,j � ❑ Yes ❑ No
�e V�VenY in Guestim: MmieOY Asse55eE
Real Roperty ❑ ArmualyAssessed
�A� 03�.�_9
lM�3l Tadn. � .{— (� '" _ (� � -_ . —^""." ,,,� .
U �`1G W KJIL,`-���
2a
I/ we certify uMer ihe penalty of perjury that the above aM foregoing infortnalion is tr
owner 1 contract buyer of the atorementioned property.qn date application is filed.
� � �
� Fu0 resdent adEress U
Person authoraetl Oy di
person (number aM stree; ary, sfafe, anO ZIP mde)
�olo-S�g�
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