HomeMy WebLinkAboutMortgage_Russell (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T ip Year
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+ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fdm 43709 (R11 / 6-09)
�` p PresttiOeE by Department of Laal Govemment Finance
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1STRUCTIONS:
To be filed in Form med wN�:
person w by mail wifh the CountyAuditor o�COUnry RecoNe� of the counry where the pmpeRy is bcated. �.
Fd"mg Dates: 7) Real Property: Must fife during fhe year for which tlie deduction is wughG �� ���
2) Mobile / ManufaUured Homes rrot assessed as Real Pmperty: Must file dunng [he tweNe (72) months
before Maah 37 of each year the deduclion is sanght ❑ Coun er
GI SON
See reversa side /or addi[ional instructions and qualifications.
Mt�N(owne�orcontrae6uyer-3FeresbirZUns reverseside) '
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dreal pWeM1yaSOf
If ro, what a his I her exact share of interest?
rl ICya10P5CnptiOn
� -aa-o�- aoa-000. 30�_
AloRqage / Contract'udebiedrress unPaiO as N hbr�qage / ContraG'vic
Marrh 7. airtent yrar date ol apPfmalim J
If name on �emr0 5 tlilferen� Nan ihat of aPpfirant, uWibte belovr.
Name ot mortgagee or mntrart
mat9a9ee or
nmer rn mortgage
city, sfa. . a�
Aaa2ss ot asvgnee (nurwer aim suee4 �Y. s,a�e. ano ur ooae�
F -�r� � .3a,��
Ooes applifaN ovm properry in any oNer If yes, wfiat munry?
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amouN
tl ovrt�eC x�N
COUNTYAUDROR
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Q(� 4ga� a e�nmtle awneY7
/7 ❑ Yes ❑ No
sPouse. iMifate wfih vihom
Is tl�e P�GQnY in OuesEOn: MnuaOy Assesse0
�Real a'operty ❑ nnnualywssQSUa
RGSS
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/ I � 1 � �:J
20 � 2q _ � 20 � 20 _ � 20
I I We certify under Ne penalty o(,�erjury that
owner 1 contract buyer of the afaementioned
Sig�anue (ownels M1Arame) . �
Ey EWy ezecutetl Power of AtlOmey m
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Fi�]
e arW foregoing infortnation is true and corte�Y arM that ihe appluanl is a resident of IrWiana and
on date appliraaon is fileG.
� Date (rmtth, day, ysa�
a�d
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Address W auihor'¢ed persa+ (number aiW stree4 �N. s+ate, an0 Z!P aotle)
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