HomeMy WebLinkAboutMortgage_Stephens"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS , oun :- _ 7 hip Year
�_ .: FOR DEDUCTION FROM ASSESSED VALUATION �
• State Fortn C3709 (Rt1 / 6-09) � .
, w�. � Prewibad by Department of Local Gwemment F�nce
File Mark
iNSrRUCnoNS: S EP
F
To 6e fiied in person w by mail with the Counry Auditor or Counry Recorder o7 the counry where the property is located.
Filirg Dates: 1) Real Pmperty: Must file dunrg the year for which the deduction is sought. County Audiwr
2) MobBe / Manulactured Homes rrot assessed as Real Pruperty Mus( file dunng the twelve (12) months�
be(ae March 37 ot eacA year the deduction is swghf. ' nry Recorder
Se varseside7oradditionalinsWCtbnsandquelificatrons. _. G�BSONC , �y
�(/m�merwconvacf6uye�-see ' nsmreverseside) .
f fl NV\ nJ� � � t� � L � nn n A
Taring
ro. x1w161�s l lrer e�
Key nunber I legal aesrnvlion
a�-� - - �y-
�age / Contract indehta
1. n�rtent year
If fwrie m recwE is SAferent lhan ihat d app6�nt ��� belo�'
Name ot rtaryagee or contracc seqer
Address of rt�artgagee «mntraa se0er
Name of assignee w
��.
morigage
slete, end LP aotla)
Dces epplipnt own property in any oNer
munry in IMana? ❑ Y�
❑ No
Detluctlm epproved in Ihe amount oF.
20
Sigria�rte U Co�a:b AWitw
number
unpaid as o( � dMOrlgag P/v��C intlehtetlnrss unpaid as d I Is�NI
If wmeC wiM someone Nhu than spouse. iMimte v.iM wtbm
numbc
❑ No
in puesUOn: Mnua�y AssesseE
ertY ❑ NmuaqyYAssesud
Drawer NO..aW�........
���.���,�m �,rap�o� Card i�'O. ..C9.W1�..........
No
�'�$,oco. � —
couNTrauoROR _
2p _ � 20 _ I 20 _ I 20 _ I 20 _
Date (monN, day, year�
i'.i'
�/ We certify under Ne penalry of perjury Ihat Ihe above and foregoing infortnatlon is We and cortect arM that ihe applirant is a resident of Ircliana arW
owner / mntract 6uyer of ihe aforemerrtioned property on date application is 51ed.
�reoue fo�merS fiA namel Date (month. daY. Y��)
addfes ol appGOnt (number aM sbee4 dtY, ��e, and ZIP cotle)
19 ut�s r Cs-� c.�c. E S i � A-icLA-�v0 G rrY ,!� u`t G� O
urzeE Cy O�dy ezecuted F'ower otAttcrneY ��' IC 61.1-12-0.7 Date (rr�
aWio�'ued persan (number and strce4 ciN. state, aM ZIP code)