HomeMy WebLinkAboutMortgage_Acton^' STATEMENT OP MORTGAGE OR CONTRACT INDEBTEDNESS un T ip Year
, FOR DEDUCTION FROM ASSESSED VALUATION � /
Sfate Fwm 43709 (R71 / 6-09) j/
, y„ � PresaibeE M�Pa��^� o! Local GovemmeN Finance
AUGF� �
wsraucnoNSr
Form filed wNh:
To be filed in person or by mail wifh the CountyAUditw or County Recorder of the county where the propeM is bcated. �/�
Filing Dates: i) Real Property: Must file dwing fhe year for whirh Ihe deductbn is soughG G�« !�(",dYAty Audhnr
2) Mo6Be /Manulactured Homes not essessed as Real Pioperty Must file dunng Me hveNe (72) months ��,]� (/
6e/ore March 31 ofeach yea�the deductnn is saght. G1°SOP C(,`::`�T��R�der
See reverse side for addilional instructions arM quel�ications.
(owner orcontraC bN'er - soe igsUirDUns m rayjrse side) • a �
�� T '�� � Key iwmDer / iegal desaiVtion Rewrd numher Page numbel
��aµ.�..-� ab- aa.o�-�oo-oanooi-ooq o �a `7
AssessM rAue d real D�P�Y a ot Mpr(p�g e/ Contra�t inde6tedness un0aid as W Mortgage / Contraa udebteOnrss unCaid as d Is Me aOP��� Na sok
Ma�tli 7. arrrnt yw Mard� 1, anent yeer date ot eOP�� legal or epuilaNe ow1reR
� (� ❑ Yes ❑ NO
If m, what is his l lrer ema share of interest7 H awned wHh somea� oCmr Ihan spouu, udirate Wih wlnm
tt�rtre m mmN b E'iftertKrt than Mal of aPP�=• uMiram hebw. Is ihe PP+�1' in Vurstian: Mnua�y AssesuE
eal RoPertY ❑ %vmualhl Assessed . . _
Nartre 01 rtaR9a9ee or CMtract SeAer
. r,c.0
ACdrea ol nnrt�jagee or cmtraG seAer (number and saee4 �Y. sm�. ai
Name af asignee v oiher awner w IwWU ot mor'.gage
ACCress ol av99nee (number anC stree4 �: sfete, and code)
i F � �-v-rr .� a�a- A �
Oces e �-am own yoperty in a'ry other It yes. what munty.� Vlhat Tawg Dctri�s7 Fias No Ee�on Deen reGUested m prapvty
��ry����� ❑ Yes ❑ No ���� ❑ Yes ❑ No
COUNTYAUDROR
DeOuclion sPWwed 4� itre amount aF. r aO /�
Drawer \0 ...................
2p_ 20_ 20_ 20_ ' '. �/ —
Card NO. ...y�1,
Sig Gae of Camb Ndiror Ca��Y • • � • • • • • . —
�TFC y � ry�, oco. °° _
I I We cert'rfy u r fhe penalry of perjury at the above arM toregoing infortnalion is tru 3^d
owner I contra buyer of Ne a(orementioned property on date appliration is filed.
SIa�qGVe lawnefs hAnamel . ��. daY• Y�A
adEress of appl�lant (numbar anE stree4 tiry, �are. and
Date (rtpnfh. dal%
P4dr�s ot aWio�rsetl G�� (number antl sneef, c%: stete.