HomeMy WebLinkAboutMortgage_Hoffman"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
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= FOR DEDUCTION FROM ASSESSED VALUATION
� State Fdm d3709 (R71 / 6-09)
�' .u. � Presrnbed �y DepartmerG W Loral Gavemmem Firiar�ce
INSTRUCTIONS:
To 6e fiied in person w 6y mail with Ihe CounfyAuditor or Counry Recorder of the counry whe2 Ihe properly is located. F
Fi7ing Dates: 1) Real Property: Must file dunm� Ne year for which Ne deduction is soughL i
2) Mob�7e /Manulactumd Homes rat assessed as Real Prt�peerty Must file dunng fhe twelve (12) months
before March 37 07 each year the deduc0on is sought.
See reverse side /or additional insfructions and quelificafions. �
AppGfarSY(�me^a � 6N'a/-f � � °� ��rse sidel Q�B$QN
' �- — - oa- � �s- oo
�A�d poperty as of Abrtaage /�COn � e6letlMSS unpaid az W aM �Ig (9e�� mtle
mh �
I( fq. wh8l IS IYS / h¢f ¢l0Q ShdIB Oi VI�CRSI? H O'MIBC WiN SIXII¢Ofl¢ OfhBl UNII
tt fwrie m remrE's Qi,ierent than Nat of aOP��. rt�Aifate Delow:
Name m mutgagee or contraCt Seller � —
Add2ss W rtiort9a9ee or mnhaG seAer Inum6er and stree; '
Nama of assignee w othu wmer rn iwlder af matgage
AOCress of assignee (number aM street �Y. sfate, anC LP ootle)
Oces ap�nt oxn popnrty in any other If yes. what
LP rode)
Cd�DP.I l'I_Pl�l Y i1:7
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m fiied with: (�
� ��Xuditw
❑ Counry Remrdes
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� � kg31 p equitade awne(1
❑ Yes ❑ No
:GO�. iMicata wBh whom
I-s7N��e properiy in pu�tiati Mnu80y ASSe55ed
�{! Real PtoPertY ❑ ArourdOY Assessed ._.
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20 20 20 20 2q 20 20
�(unrte ot CowN Aueitor Counry Date (rtaNh. daY. Y��
I I We cert'rfy urWer the penalry of perjury that the above aM foregoing intortnatlm is We and mrteG and Na[ the applirant is a resideni of I�iana and
awner I mntrad buyer oi Ne afaementimed property on date apPlication is iiled.
irature lawnerS M1ID name) � Date (rtrntl; daY. YBaA
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�mDer and sbee4 �: �te. aiN LP code)
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� ana�er «oy iC �i.t-t2-o.�
Ser aiM sbee; dry, state, an0 Z!P cade)
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