HomeMy WebLinkAboutMortgage_Houchin"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ FOR DEDUCTION FROM ASSESSED VALUATION �
• State Form 037W (R71 / 8-09) (� �
S y�. � Presaibed by DepaRmerrt o1 Locai GoremmeM Flrenca
�� File Mark
INSTRUCTIONS: �
Fortn f�ed wtth:
To be (led in person w by mail with the CountyAuditof o� Counry RecoNer of the counry where the pioperty is located.
F7'mg Dates: 7) Real Property Must file durim� Ne year /or which the deduction is soughG � Counry AudRw
2) Mo6de / ManWadumd Homes not assessed as Real Property: Must file �unng the hvelve (72) monfhs
6efore March 37 0/ each year Ne deduct;on is sought. � Cou^ty Recorder
See ,evarse side lof adtlitiunal instnxtions arM qualificafions.
i10W4�P� (owr+er or mntrarY buyer - see m re�+erse 5iCe) ._ � t
�dng District Key nmber / legal desaipUm Rem�d number Page number
a,(o - - - D 3-DDD. 7/! - o0 7 O Yo5
A�ed rahie U r� d e/ Contraa irdebtedness unpaid as of MMgage / Convaa iMebleOness unpalE as d Is Ne epp0�sni the sda
ra e g
Mmd� 1. a�mY Ymr t. artent Y� tlafe W aGP� kpal a eWitade rnmeR
y ,2o a ❑ Yes ❑ No
tt no. whal Is Ns I �er eud share Ot Nterasl? tt ownetl wtlh someane otl�er Ihan spouse. uMicate wrth wMm
H �arte m remd'e WitrJ�t tt�an Ihat W epp6raN, trMifate Eebw: �Is N!e P�P�Y in 7uestim: Mrn�a%ASSC�eE
C! n� �P�KY � �!!�M � . . _
Name o/ m
Add� oi
Name o1 s
PdCress of
�
���
Daducfion
�
rtqagee a mntran seDer �/�
rtprtgagce u oontract se�er (nuMnl nd sheet, cdy. smm. eM LP code)
signee a othu ormet a MMer d nqrtgage
a��n�u� (wm6erad sheet �N: smte. antl LP mCe)
%dah-�o�.'�� Q,o�-OL o� �
��„��m a�Y�« ���.�����
�
�I/ We certify un�r Ne penalry af
owner / contract buyer of Ne afor
'� Si8 (owrreY:lu�iwr») —
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COUNTYAUOROR
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o� � , .
.Card NO. `.:...��.J�.y........
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2q _ 20 _ 20 _ 20 _ 20 _
Counry Date (month. dfi: Y��
the above antl foregoing infortnatlrn is We and corteU arM that Me appli�ant is a tesiderrt of Irdiaria antl
property on date appliplion is filed.
Date (rtmth, day, yea�
Fu0 �idant aONess U appGant (num0arand sbeet �Y. ��. �
13! � 6�l�son Sf �ZKlsnc�
Pr�son auCnrireE Cy duy rxacuted Foy�er of AttaneY a q' IC 6t.
PddRSSOtaWmr'vr�7� (numberandsbeet�:stafe.and2
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