HomeMy WebLinkAboutMortgage_Tenbarge (5)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS To Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
$tate Fortn G3709IR71 / 6-09)
S,,,, � aresoited ny DepartmeN of Lord Goremment Fuarm
INSTRUCTIONS� � F �a���u
To be filed in person w by mail wiM the CounryAuditor a Counry Rewrder of the counry whe2 the propeRy is located. F� �� �:
Fifing Dates: 1) Real PropeRy: Must file during Ne year /or which the deduction is sought. �^y��y q��y�
2) Mobde / Manufadured Hortres not assessed es Real Property: Must file during the twelve (72) rtanfhs
before ldarch 31 o/each ysar the dedudion rs uught ryRecorder
See ieverse side for addiliunal instructions erW qualificatbns.
GIBSO DITOR
(owre� or ravrae - see mxrictbns re`dm sde)
a a•,,ata,
Tating DisVirS Key rxanbu l kgel desvipt6n Remfd rrym¢er P e
- 9�31-3o3-ood. -oo i0
A�sed rahre d mal pfaprl,y as ol Abnpag e/ ContraC iMeWeEness unpaid as of MMgage I Conrxi cWebteMess unpaid az d U ihe app8rant tlre mle
'Mmtl� 1, cvma year Mart�h 1, arte�rt yeer date a( appfimtion �egal a equttade wmeYt
OOO ❑Yes ❑No
tt no. what k his / her e�md sha�e of internsfl If mnad wiN smware W�er ihan spouse, iMrate with whom
'��
tt narre m remN a d(Rerent Nan thal W aGP��4 tr�d'uata Ee1mr. __� �oGe+�Y in Ouestion: Mnua%PSSessetl
Dra�ver N�....���Q..... ,,�� ❑,�,�,anr�
edod�e Flane �c 6,.,-
N3me of mOrtgagee or mntrar2 seAer �
Addrea af marK�agee w mntract se�er (numDer e�
Name d assiryiee or otl�u owner
PdA�ass ot assignee (number antl sheet �: s+ete.
� ..a���......
u . Card ND• •
�a5���.�
n
Imunryein�ly d'ana?� � ❑ Yes �� ❑ No I If �. whal munt� I Wha� Tadng D'svirl7 I for artent y�uoim Eeen ❑ Y2s� ❑ No I