HomeMy WebLinkAboutMortgage_Stolz (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�_ FOR DEDUCTION FROM ASSESSED VALUATION ��
Slate Farm 43709 (R70 H 7-08)
� � Presaibad by DeparN�enl W Lor� GwemmeN Finanw
�NS7auCnONS: pFle Mark
To be filed in permn w by med with t/re CountyAWHOr o/ the county where the property is bcated. � U N O 2009
Filing Dates: 1J Real Piope�fy: Must file dur'mg the yea� /or which fhe deduction is sovght.
2) Mobde / Manulacfurad Homat not assessed es Real Property: Must fde durirg tlie lweNe (12) month`s— 76�ef�we Ma�ch, (3�1 o�/earh yee�
the deducfion is sought " �� V
See reverse side lor edditional insWdions aM qualificatians _
A5:9s5eA vduB d �wl propeNy as
Mam1� 1. nmaN yea
��
� / Canirad c
wrte�n year
Y ro, what q ho / her exad shara d imeresY!
C rertre m reard is ddfarem ttvn uut of aoc�l "odimm belar.
Name d mortgagee v contraG sa0ar �
nearess d morty�ee «w�craa seaer Q,unner and s�eec �: sl
Hama d assigrree or atl�er owner or Iqlder o( mortgape
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5 rot,Z
DOes a,witan� Cnn pm�ty in arry olhar I/ y, I'� D(" y B
tounty in InEqia7 n., r.y ..
1 as tl MMpape / Gontratl intlebtedne!
data of ppG tion
I( wmed with someofre ather Uun sGase.
Deduciion app�oved in Ma amouM d:
20
5gnalura d Couiny AuEilor
20_ � 2f1_
u�
20 _ � 20
un W b� d I Is Ihe appGfaN Iha sde
lepal ar equitabie owneR
❑ Yes ❑ No
5 ihe P�M in Guestion: Mn�
��� ❑RealPfoperty ❑Mnual
Mobile
Ihis dedudian been repuested an plopeM
unBnt yea(7
❑ Yes ❑ Mo
20 I 20
I/ We certify under the penalty of perjury that fhe above and foregoing u�fortnation is We and oorred and that fhe appfiranl is a resiaent of Intlia�u arW
avner / mntraft buyer o( the aforementioned property on date applimtion is filed.
��yra ( s 1�iwncl //, � � Date (rnonN. CaY• 1'�a�
L�
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rlfy, 5mte. ard LP Code)
&7.
Date (maYh, Eay, year)