HomeMy WebLinkAboutMortgage_Davis (11)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T shi r
__ _, FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fwm 43709 (R71 / 6-09)
�' 1 Presaibed by Departmeril af Loral Gwemmenl Friance
n. �
wsraucnoNS:
To be filed in person or by mail with the CountyAUditor or Counry Recorder ol the counry where the pmperty is located. -
Fi7irg Dates: i) Real Property: Must �le dunng the year (or which the deduction is sought. � �, ���
2) MobBe / Manufactured Homes rrot assessed as Real Properfy Must file dunng the tweHe (72) months
betore MarcM1 31 ofeach yearthe deduclion is sought. GIBS N�Ut(bMr�(1{81�lW
See reverse side for addi6onaf instrvcGOns arM quali�cations.
MP�nt (owneror�traC buyer, see restri�.On��n rererse s�a n ^ 1 n �� - t�
As�ssetl vdhie of 2a1 poperty as of Abrtpage / Cano
MarG� 1, qnrnl yPar MyiCh 7. arten�
' _
If m. what fs his / her erad shara of intrlest?
tt rwre m�eornd is QAturnt lhan that o/ aPP�M. cM'uale helrnr.
ACEress d nnrtgagee ar mntrad se�er (nurri6er end street taY. sb�.
Nart�e or assgnee or otl� mmer w hdaer of mnngage
Mdress o( assiqnee (number artl stree4 �}: s+ete, and LP code)
Oces epd� � P�G�Y in any olher If yes. what m
DeducEOn approved in Ne amount of.
Remrtf numbu Page numbv
` o- 20 LI
lrress unpaid az of Mwtgage / Convad'vde6tedness unpaid as d Is Ne app�nt the mle
7� Oate of appGfatian legal n epuitade an+ie(.+
lJ ❑ Yes ❑ No
If owned with sameore� I�1�-�"e°°
�,�a�� �C� —
1.1-7
,�,a, �35, �u . c� —
ao �� - a2-�� -
GOUNTY
Vlha�
20 _ 20 _ I 20 _ 20 _
Signanne of CaunryAUtlilor Caunn
I I We ceNty under Ne penalry ot perjury Nat the a6ove arW (oregoing infortnation i
amer I contract buver of the aforementioned property on date aoo�ication is filed.
F ' ent address of appGmnt (number arf6�tiee4 bN, state, aM ZIP code)
y o .s � /al � D ..� �,• riv -Y��6 a
asan aufhwtred by EWy ea-e�vted Power of IltlomeY a bY IC F7.1-12-0.7 Oate (rtpnth, tla}; yea�
MCress of aWwrtreO per�.,on (num6er aM stree; ciry, sfare, and LP cade) .
Y
�