HomeMy WebLinkAboutMortgage_FranceC J
."'^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C row ear
_ FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fartn 43709 (R70 H7-0e)
��.0 � Rescribed bY �W�nment tlLOr� GovemmeN Firanm
INSTRUCTIONS: Fle Mark
To be fded in persa� or by mad with the CountyAuditor d Ihe county where the property is located. . �/
tiling Dates: iJ Real Propelty.� Must file dwing fhe yeer /or which the dedudion is soughk l� �,., ,Q/sya
2) Mo6Ue / ManulaUuied Homes not essessetl as Real Properfy: Must frle tlunrg tlie fwelve (12J months be�Ma�A 37 o/�cfi year
thetleeuctionisswght GI°SON CGU2JTY AUDITOR
See reverse sCe for edd,iional insLVCGOns aM qualificafions.
MDGtlnlbMnermmN2rldNar-5eB aniomisnsEel
Key num6er / legal Eesaiplion
a� - i -r � -300 - o00
y es d Mortgage / LonUad indebletlness unpaid as d
Mamh 7,�;
7[eY�00 D
�J
tl name m iewd is dINe�aM lhan
Narre d matgagee a mnlrac� seEer �� �/
(%
AddR4s d rtorigagee a tmltad seAer (nun6e�aM stlMt My. sm1e. atl i
Nama d assigree or othar owner ar holdar d mat8a0a
aea�s e�igree (num6or aro abed. rdr• sam. a,e z�aaoee)
Oae� ePpG�nl own PmpeitY in airy alAar tl yes. what muMy?
mumy m IMiare9
n Yes n No
������wa��
2(1 20 _
Sgn IwadCouMyAuEdor
.../
I/ We ceAify u� � e penalty
owner I contract buyer of the a��
Signature (wvrie/S hID name) / �
i ��z
FuA residant aEEress af applicam (ivai
��7 -ov �,
� ,�:T
d number Page numher
009 9�(0
If wmed wilh sameone oUter Ihan spuae, iMrate wiN rfvn
��I�Tii
Yes ❑ No
7eM in Quas7ion: MnuaOy Asse�ssed
ProPeM ❑MnuaDyAssessed
..I fw aataN YaaR
I
�'Ju7
COUNTY AUDITOR �- --
D��a{ver'lYQ ��
.. ��
20 20_ C.�1'�1\�O• • .��� •.
, �"" � q�, ��, � � � � �
the above and foregang uiformatian is We a� oorred and thal Ine..�,
property on date application is filed.
city, sta�.
n
Addrass d aWhor¢ed persan (nunEniandshco4 �: sbM, and LPOOOO)
a and