HomeMy WebLinkAboutMortgage_Herres"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ . FOR DEDUCTION FROM ASSESSED VALUATION
� Slata Fam C3709 (R71 / 6-09)
�,.,� � P�esaiEad by DepartrneN of Lo�l Govemme�ri Finance
INSTRUCTIONS:
b be filed in person or by mail with the CountyAuditor or Counry Recorder oI the counry whe�e the pioperty is located.
Fiing Dates: 1) Real Property: Must file tlunrg the year for which fhe detluclion is sought.
2) Mo6de / Manufactumd Homes rat assessed as Real Prt�perty: Must file dunrg the hveNe (12) months
before MarcA 31 of each year the deduCion is sought.
See ieverse side 7or addRional inshuctions alM qualificafions.
Mammi oo0(rattCN'e�'see vers� e� .. n n_ n
(Ta�q(gbi t • Keytwmber/leg W �pfo � �
V lX � �
Asessed raWe of �eal property as W M age/�p tract iMehcetlness unp
A1emh 1. aimv Yvr Ma� 1. wrteht CxO ��
1
I( ro, whal is his I hef e�a share Of interest?
tl nama on 2cUrC e dtlfemnt Nan thal of appOCan4 �di�ate �ebw:
Name ot rtnrtgagea or oontrart
contrap sr�er
hdderafrtqrtgage
AdC�ess ol assigtree (n�mber aM atree; dry, stete, antl ZIP m0e)
Does epplimn[ ovm {wperly in eny aNer If yes, rTat
muniYU�lnda�� r-i._ r�_.
'LUIU
Auditnr
Page
d as W Moriga9e / Canaa�i iMebieCness unGaid as d Is ihe aPP&ant the sde
date af applifatm legal a equitable ame(1
� ❑ Yes ❑ No
IF wmad with sameone oNer Ihan spouse. 4dimte with wFrom
Is the pmperty in Quesbon: MmiaM Assessed
❑ F2eal PfDP�'RY 0 ��Y �
Whal Tadig Distrirl7 Has iha deEUaim been requested m poperty
�� w� � ❑ Yes ❑ No