HomeMy WebLinkAboutMortgage_Obert (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION
• Sface Fortn 43709 (R11 / 609)
�' ,.,. � P�eulibed by OepartmeN at Loml Gwermrenl Frence
File Mark
INSTRUCTIONS:
To be filed in person w by mail wiN the CountyAWitor or Counry Recorder o! the co�nry where the properry is bcated. �
Fiiirg Dates: 1) Real Pmperty: Must fde dunng the year (o� which the deduction is sought. I a uditnr
2J Mo6de / Manufactuied Hanes not assessed as Real Prtipeerty: Must file dunng the nvelve �72) months C� j�5�"'��
before March 37 of each year the �de�duclion a saght I J �
See 2vers�}ide foradditional instructlons and qualJl�cations. [:IRSON C
U i
Assesed rdue d rmi pfopary as d Mortuage / Contraa u
� 1. amn[ year Mard� t. a�rtent year
It ro. what is his l Icer erxl share oi interest?
tl�rt�e m �eoottl is Giftermt ihan that af aGP��. uMkate belmr.
Name oi mortgagee a mntrar� seiler 4�-��/�
Addr¢s of rtornJagee or mntrad se0er (nurtibri and snce; uly, e, and i
Name af assignee or dha ownet or halCer of nartgage �
c
AEtlress ot assignce (number and stree; ray. slafe. antl ZIP cotle)
Does applifant oxn prope�ty in any oNer If yes. what munty.�
m,�uy m i�e�z
❑ Yes ❑ No
20 I 20 . I 20
TE!�
�mpaid az d Is Ne appOcant Ne sde
�-�{'� legal U epuildNe oxnM
� 1 R J n Yes n No
Real Roperty Q Nmua',
M1bb7e
_ _—
�� pt3� S�G� �
� y
W�at'
— ao► � � 33'
20 I 20
J
�Y
� No
20 _ � 20 _
I I We certify u�er Ne penalry of perjury that the above anC foreguing intortnalion is true and cortect and Mat ihe applipnt is a resident of India� and
owner I wntrad huyer of ihe afwementioned property on date application is filed.
�Sip� (o e/s Date (monN, day, yee�
� Fu ' en( aNlress o( appficant (number ard streeq dfy, stafe, aid ZIP code) , _
a6 S So� .f3 w �/7
Pelson auttrofaed Oy duty ezecuted Power of AROmey or by IC 6t.1-1 -0.7 0� �mo�,rn, eay, y�r�
AEtlress of autlwr'¢eE person (num0erand streef, ciry, state, and ZIP cade) ,