HomeMy WebLinkAboutMortgage_Lanham"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Sfale Fdm 43709 (R71 / fi09)
,' ,.,. � Presfiibad by DeVartmeN af Loml Govemmerit Rnance
INSTRUCT70NS:
To be filed in person or by mail with the Counry Audito� or Counry Recorder o7 the county where the property is located.
Fifirg Dates: 1) Real Pmperty: Must file during the yaar for which the deduction is sought.
2J Mo6�7e /Manufactured Homes rrot assessed as Real Property.� Must file dunng the M1vefve (72) monfhs
before March 37 0/ each year Ihle deduction is sought.
See reversa side 7or additional instructions arM qpalficatbns.
Asrssed value of real @opcty a5
Mardi 1, WRnt yP2r
IYS i IM! CZ2U SINfB Oi If11PJE5I�
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COUNTY
�' !� V O HCWIU rt10P1 Y fl . �
�/ Contract iMehteE�ress unpaid az W Mortgaqe I Contrart udebtednPSS �mpaitl az d is Ihe appfrcant Ne sde
arte�rt Y� date of apPfication ?/ /��y� ieyai a ea��ude o�,ea
�O�l CO ( .I.AJ ❑ Yes ❑ No
11 name on record "o Eiflerent Nan Nat of aVP���. mGilate below.
rlame at rrortgagce «mnraa senu � �
AAdress o( mortgagee w wntraG sWer (num and stree4 �'. sbte. ard LP
Nama ot assynea w otl�u owner or holder ot morigage
AOCress ot assignee (num6er entl aveet, tlry, slate, and LP code)
propc+cy m question: MrwaM Assessed
�1 P(oPeM1Y ❑ %vm�al�Y Assessed
rnowie rw�,e nc s
��� 2 �,A� �AM
����y A
any oNer I If yes. what wunt/1 I VJhat Tabrg OisUict7 I I'� I��
Yes ❑ No
COUNTYAUDROR
Deduc7m app�oved in Ihe amouM of.
20 _ 20 20 _ 20 _ 20 _ 20 _ 20 _
SigfanuedCamryAUeitw —X,j Caunry Date(month.daY•Yea�
UI
I I We certify under Ne penalty bf perjury [hat the above and foregoing infomiation is We and correU and ihat the applinn[ is a residenl of IrWiana a�
owner / contrad buyer of Ne aforemeMioned property an date apD����n is filed.
Si9 (owner9 /W na ) � t Date (mrnfh. daY. Yea�
,l.cr2�"i
. uh �dent ��ppfrant (numDerand sheet tiry, stJate�, and ZIP e) �
S V
Person auNwaeE Cy tluty execute0 Powei af Attamey rn by IC G7.1-12-0.7 Date (mprN. day, yea�
AAtlress of authoraed person (numberentl saee4 �: state, and LP code) .
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