HomeMy WebLinkAboutMortgage_Hazelwood^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Yea
__ � FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 ! 6-09)
�'` � � preurip¢C ryy �epartment of Laai Govemment Fi�nce
File I
INSiRUCTIONS: F� m� �:
To be filed in person w by mail wifh the County Auditor or Counry Recorder o/ fhe counry whe�e the property is located.
Fd"mg Dates: 1) Real Property Must file d�rng the year /or which the deduction is soughL �U 4� Z�nty Auditor
2) Mobde / Manulactured Homes rrot assessed as Real Property: Must file dunng the tweNe (12J months
before March 37 0! each year the deductinn is sought. C� � Caunry Recorder
See reverse side for additional insVUCtions and qualifrcations.
qppGnnt(ory�erorconvaabuyer-seeiestr�'cixtsonre�s�ie) A � BSONCOUNTYqllnirnr,
.,�sed �2hre d real P�nY 3�
�2hre
arm 1. amrn� year Y
no, whal is his / her emtl share
If name on recad a ditferen� Nan
number I iegal desaiption
2� - /Y—
ge / Contra�
�. wrte�c n
tr�dicate Cebw
r3meofrtronc�a9eewmnVaGSeller /- � _ TG
Ciu-rt.r�
Address ot mortgagce w mntracl seller (number end sbee; ciry, slate.
w other rnmer or hdder ot mMgage
�(number aM stree4 dry, sfate, arc
Oces aPplimnt own property in any oNer �/
�'������ n Yes ❑ No
_ 30/ - ao/. D3 S -ao
debteC�ss unpaid az of Mongage I CmtraG i�ebtedr�s impaid as W
Eate o! appikation��, 7-�
�OV
It avmed vriN someone oMer Ihan spouse. indipte v.ith v
Llf' LOtle. 1 _
� �. ��
� D�
�I5,t{� property in O�stion: Mnu:
LJ �� ��Y ❑ Afmual
Moble
�dade ovrtcer?
Yes ❑ No
�
H/-lZELI,Jc� l� , �0/�N" � S
/ ol ol (.�'i
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