HomeMy WebLinkAboutMortgage_Ingle"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ , FOR DEDUCTION FROM ASSESSED VALUATION �
State Fortn 43709 (R11 / 6-09)
�' ,.,� � Presaibed by Departmeril af Loml Gwammenl F�
File Mark
INSTRUCTIONS:
To be tded in person or b mail with Ure Coun Auditw w Coun Remrder o/ the coun where the F
Y ZY N b woaeM is kcared. N O
Fifirg Dates: i) Real Property: Must file durirg the }rear lw which fha deducLOn is sought � Counry Auditnr
2) Mo6Ae / Manufactuled Homes rat assessed as Real Property. Must file dunng the tweAre (72) months �
before Mardr 37 0/ each year the deduction rs swght �., ���eunty Recordu
See reverse side foradditional insfructlons and qualifirations. BI�SAN EdUNfiY A-llB�iBp
I Mv�M (ownei mcontraalv�'er- see ret�u m iaverse side) __
���� � ab� o�3d-3�-o00.3�9-oa/ �"p p P�ew aS
AsxsSW �2Am d mal pmperty as d Abrtpap e/ Cantratt intle6letlness unpaitl as a( Mortgage / CmbaG'vNebted�ss unG� as d b Ne ePP�t tlw sola
Me�U 1, amnt y�r Ma� 1, wrterrt year date af appfrcatm legal or equitade am�l
❑ Yes ❑ No
R ro. what Ls h'a ! her eYa� shara of inNmst? If awned wNh mmearre dher than spouse. i�dicate with wMm
I7 nartie m n,mC a drtfemnl than Nat o( aPP�L trW'xate helaw. ,I�s tl,�`e�,y� m GuesUOn: MnuaDy Asussed
L7� �PeKY � ��N � _
or rnntract
matgagee w
sbeaf, crty, sbte. and ZIP code). �
Name of assignee W other ownu w hdder of rtprtgage
MCrass of asaynee (numbe[erd sveeL �1: state, aM
yopeny in eny oNer
appro.ed'vi tlre amoum ol:
zo
1
Sigrewre W Coimb Autlitor ,
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u yes, wnet mumy?
COUNTY
zo _ zo _
`i, So A�'
wna� r�oy om,;at r� u�s aea�a�, o�, reou�m d, vroc�r
fm a�rrent Y�n ❑ Yes ❑
I/ We certHy u�er the penalty of ury Nat Ne aDOVe and foregoing infortnation is true i
owner I mntrad buyer of the atore entioned property on date applicatlon is filed.
FWI resiEent
Per„on authoraed Ey tluty e�cecutetl
.�
author¢rL person (number aM streef, dry, sbfe, an0 ZIP oode)
Dra�ti�er NO...�Q)(Q......
Card NO. .....rJj.'I.c�.S......
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oa� ��r,or�m. aar, r�n
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