HomeMy WebLinkAboutMortgage_Brown (28)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
_ s FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Form 43709 (R71 / 6-09)
�' � ReuriEed M�V��M N Laal Govemrt�eM Fu�ance
�«.
INSTRUCTIONS:
To be filed in person o! by maii with the CountyAUditw or Counry Recorder of the county where the property is located.
Filirg Dates: 7) Real Property: Must file dunng the year fir which Ihe deduction is sough[.
2) Mobde / ManufaCured Homes not assessed as Real Property. Must file dunig tha nveHe (12) months
befwa March 37 0/ each year the deduction is swght.
See reverse side /or additiunal inshuctions end qualificafions.
Mp(ir�pt,{owner or oonvae buyy� sea ryyriraons m iewrse sida)
�
'rc ro. wnat m na � trer e�e dwre or inrerxst? —
M �urne m remrE's QiRum[ Nan tAat N app�an4lndirata belaw.
Name oi mptpagee «mntract seller
Address of rtartgagee or mntract sr�
�
', Oces a��rt own property in a�ry dher
��, cwnry m �naiarwa ❑ ves_ . ._
DeEuctlon apywed in Ihe amount
smm,
rtartgage
Counry Auditor
- 000. a3s- ao �°° ��` ��°�
etlness unpalA as W Moriga9e / Can7xt cWebtedness unpaid as d La Na eppBrant the sde
� Eare of a7P�� kgal or Wuitable owneYt
❑ Yes ❑ No
If wme0 wiM snmeone dher ihan spouse. Indicete with whom
Is Me W�Y in que5ion: MnusOY Assessed
� RPaI Pruperty Q AMUally A55es5ed ...
��w` , '_ ' ' ' ' '.
l�r�r� is -
�' 39,� 08 � -
ON�
� daduGian Oeen requate0 m p�opelly
❑ ves ❑ No
�_ p_ _ _ p_ �_
5'grewre d Camb Audimr I I Counry Date (month. daY. Y�A
i/ We certify under Ihe penalty of perjury Mat ihe above and foregdng in(ormaGm is We and cortect and that the applirant is a resident of IrWiara and
owner contract buyer of the aforementioned property on date appluation is filed. � --
rs hmname) r � �/_� . ' )�Y � � %1
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AOE2ss o( aiMorrzed persm (numEerarW sbeet uN. ��.