HomeMy WebLinkAboutMortgage_Elpers (10)"� STATEMENT OF MORTGAGE OR CONTRACT INDE
_ , FOR DEDUCTION FROM ASSESSED VALUATION
sa� � aa�o9lR» i s�as�
S � Presa�betl Cy Departrtient oi Laal Govemment Firenca
Coun Townshi Year
File Mark
INSTRUCTIONS: ^ ^
To be filed in S�Orm IDe vn : L
person w by mail witA the CounryAuditor or Counry Recorde� o/ Ihe county where the pioperty is located.
FiI'mg Dates: i) Real Pmperty: Musf file dunng the year for whicA fhe detluction is sought. � Counry Auditor
2) Mobife / Manufacfured Homes rrot assessed as Real Pmperty: Must File dunng the fwelve (12) months —YQ� C ��ecorder
6efore Marth 31 of each year the deducton is soughL 0�
See reverse side tor additional insLUCGOns end qualifications. GIBSON C U U ts
t(awner or mntrarl buyer - see re.w'c8ou m reverse ' S��4—�-�. C.�/
�
Ta�d Ois r1 num6er / legal desaip RemN numbrr Page numbn
a�-�9-3i- d3-000. o��-009 aoo9 �s99
As�sM va4c d real qoperty as d Mortpap e 1 Contraa indebtcdness unpaid as o( Man�age / CmraG inOebcedriess �mpxitl as of Is the appOram the sde
Mamh 1, aareni year Mart3� 7, curtent yeer1 date of appGretion legal or epuitade oxnell
1 �j a, Q O l/ ❑ Yes ❑ No
rc no, wtu� is na � ner eratl snare or interesn
If nanie on remrd'a diRerent Utan Ihat of aPP�^L �ditate belov`
Name W rtwryagrs or convaU se4u
«�,�a
owner m MIUer oi mortgage
��.
s6
If awne0 wiN someone othar than spouu, iMkste with whom
Is Me properry in Quesaon: MnuaDy Assesse0
❑ Real RoPertY Q M��a11Y Pssessed.--,
Dra���er NO......o.�. b0�....
c���a �o. .. y5°I�.......
AECress ot auignee (number and sbee4 �Y, s+efe. and LP ootle) A. rI I, 9 1 �i '�
�N ��I P"
Oces ePWipnt oxn ynperty in any oNer If yes. what munt}? tMiat Tariny �uuu. Has Nis tletluoion Ceen requested m property
munry in IMana? ❑ Yes ❑ No I tw wfrent Ye�! ' ❑ ❑ No
Yes