HomeMy WebLinkAboutMortgage_Elpers"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counl
FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 93709 (R71 / 6-09)
� d P�esaibed by DeparlrtieM af Lod Ga+ernmeM Fu�ance
�STRUCTIONS:
6e filed in person or by mail with the CountyAuditw or Counry Recorder o/ the county wFiere the property is located.
Frlirg Dates: 7) Real Property: Must file durirg the year (or which the deduclion is soughf.
2J Mobile / Manufactured Homes rat assessed as Real Property: Must file dunng the twefve (72J months
be(ore MarGr 37 0/ each year Ne deductiar is saight.
See reverse side (w addiLOnal instrucdons arM qual�cafions.
-a�-i o - �o��
�9a9e / Cantrati irdebtedn�s
March 1, ai2nt ynar
1/ ro, what is his / her eu� sl�are of interest?
It �wrie m remd is 6rtuent Uan that of aDp�'an4
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Cd�riqWpitnr
, Cpunht Remder
Remrd rwmDer Page number
- 1 ��
i az W Mongage / Contrac['vdebtedness unPaid as of is ihe eP�t Ne sde
date af apPli�tion kgal a itade oxneR
Yes ❑ Nc
If ovrtwW wiN someone oNer ihan spwiu. intlicate wi�h whom
7
6 po�perty m 0��: MmiaDy Assessed
eylF'mPenY Oqrmualh,p55essMs
MObilew--� .
(numbrlandstreef.ctry,state.aMZlPcade) � �
w ocher owner or holtler of mortgage
naaress ot assgnce l+u+�r aia sneec cny. srdre. am ur woe�
Oces a�plimnt own popnrry in any aMtt If yes, wh:
munrymin0ena? r—� .. � ..
d:
20 I 20
YM3� Ta�ong D6trv3
COUNTYAUDROR
-- — ;� ab�,� . i
�`�".�� \O S.
3c�a...
Ca,aI�O� -...•• �� �
�a°��'. ..,Y
.� Yes ❑ No
20 � 20 I 20 — � 20 I 2tl
xature d�'•amb Auditw I Coun�Y I Date (rtwYYn. efi: Y��
I I We certify uMer [he penalry oi perjury thal the above a(W foregoing infortnalion is true and correct arW Nat ihe applinn[ is a resiEeni of IMia� antl
owner I contracl buyer of the afaementioned property on date application is filed.
mawre�9wne/s Kf nar�el _ i�/% Date (rnavh. daY. Yea�
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/ll a S. Du�e�,s��'/e aQ f{ua6sfto(t-TN �763
P�rson auNU'¢EO by GWy esecuted Power o(AttomeY � M 1 61. t-12�.7
Pdtlress of author¢ed persm (num6er aM stree4 mY, state. aM ZIP oode) .
Qace (month. daY. Ye�)