HomeMy WebLinkAboutMortgage_Stence� STATEMENT OF MORTGAGE OR CONTRACT INDE
__,_ FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fdm 63709 (R77 / 6-09)
,' ! Presaibed DY �P��M a( Lo�l Govemmerrt Finance
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wsrRUCnoNS F� mm wm�:
To be filed in person or by mati wiM the CounryAuUitor or Counry Recwde� o/ Ne oounty where the property is located.
Ffig Da[es: 1) Real PropeRy: Must fde dunrg the year for which the deductbn is soughL ��qudimr
2J MobAe / Manulactu�ed Homes not assessed as Real Properfy Mus! file durirrg the tweNe (72) monMs l
betova March 31 0( eaM yerir fhe deducfion is sought. � R�w
See reverse side /or additional inshuctions and qualifications.
nsessca va4c u Ra1 PrtqenY as
Ma�d� 7, �I year
tl ro. what Is his / tcer exac[ share a( intr�est?
r I kgal desaipfion
(�- lq - 3l -?,l�
ge / Cantraa IndebteEness
1, wtRrN Ye�
i� fIMIB Ofl IEmfd 6 QIiiP.f911 iiHll a12} 0( 3p�C2111. �IfdIB �C�PK.
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andsnae4 uly. sfete. eMLP
w holder of mortgage
Adtlress o/ assgnee (numbei eM sneeG rny, state, and ZIP cade)
GIBSO fiY AUBtfibn
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Record number Page numha
-� -� 3aa
i az of aqe I Conrarl iMe6tedness unpaid az'd is Ne applkant the sde
date ot appfimtion legal w ' de owne(1
es ❑ No
If ownetl wiN snmeone dher than spouse. "udkate riM wlwm
�SI�IC G�O�rtY If1 QUCSi1011: /VIf1U8�`/ pS5C3SCd
Real Properry ❑ Armually Asse.SSed
I� e'npyita�own 0� nin ln�oNer � I It yes. what muntyT I What Terig D¢bictl I for artent yeaR Eeen rg�ugted m ❑ No I
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