HomeMy WebLinkAboutMortgage_Bratton^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, s FOR DEDUCTION FROM ASSESSED VALUATION
_ State Fortn 43709 (R71 / GO9)
�' Presaibetl Oy DeparimeM of Lod GavemmeM Fu�ance
�JSTRUCTIONS: F� fl� �:
To 6e filed in person or by mail with the CounryAuditor or County Recortler of the aounty where the pmperty is located. � U 1 Z � Z
F�7irg Dates: 7) Real PropeAy: Must file during the year for which the tleduction is soughG � �unty Audimr
2� Mobde / Manufadured Homes rwt essessed as Real Pmperly Must file dunng the tweHe (72) months C. J � unry Remrder
6e/ore March 37 af each year the deducfion is sought.
t
See reversa side !or addi�ional instructions and qualdreafions.
AsS�ssed vatue d real papercy as of I
A/a`U 1. ame�V ye�ar 1
tt ro, what is his / her euG shara of interest?
It name m 2ooN 5 dMerent than Na[ of aPp�anl
Name of moripagee or
Address of moMgagee w
IJame W
_ 300 -odo./63 -Oa
�. / Contract intle6tetlness unpaid az of Mortgage / Conbact inE
curtemyrar tlateo/appli<ation_-�
straef, cM, �te. and ZIP code)
mor[gage
(numbe�aMStreet tlry, state, an
:�J i1."�—
Dces a�i�ant ovm property in any oNer
�w�uym��aa�az r-� .,--
Deductlan
20 — I 20
Ss7naNre
of
� . �c �l f� e-
munQ/.� M/hal Ta�dng [
�
1/ We certify ufWer ihe penalry ot p�ury that the abo�
owner I contrad buyer of Ne afwementioned proper�
Sgnanue (awne/slullreme)
� �
yW residen of appfcant (number enE stieet, r�Ty, stare,
�0\i� 5 S `^� L` �1J�lzy�.]� �
Pe�san auUrorrzed by Outy esewted Power of Attaney rn by �C 1
ez��
RecoN
/ ! D
as M Is Ne applirant the sde
legal w equrtatle wmM
❑ Yes ❑ No
with vihom
Is Me Pm7enY in 4uestion: MnuaM Assessed
�ea� Provenv ❑ iwwalNasessed
����bl� 3�stv�
v.r.�cy
/�?- /G U3
oate (�.
NO
iid toregang infortnatirn is We and cortect afM Nat the appli�ant is a reSideM of Inda� aM
date appliptlon is filed.
Date (monlh, dey, yea�
�,
Pddress oi aulhoraed perswi (�umber a�d stree4 �Y. state, aM ZIP cade)
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