HomeMy WebLinkAboutMortgage_England°"� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ou ownsn p �
. FOR DEDUCTION FROM ASSESSED VALUATION
StateFam43709(R70/11-08) �U 5 - 2009
� y,� , P'esaiDed bY �GaMiant d Local GovemmeM Firtanm
INSTRUC710NS: �A^_+F�
To 6e fited in person a by med wi� the GountyAuCitor d Nie oounty where fhe poperfy is Ixated. C/
FdirgDafes: 1) RealProperty:MustPoetluringfheyeer/orwhicAthetledudwnissought � QIBSON CbUNfi� AUBlfibd
2) Mobde / Manulacturetl Homes not assessed as Real Property: Must fife durny tl�e fweNa (12) monfhs be/wa Ma2h 31 a7 each year
the deduction is sought.
$EB IBVBISB 90B iD/ 8Uf/ILOII8IIRSINCf10lIS 8lld Q✓3�I�IGBiIOflS
A07fit2n� (own¢/ n' Nrkla.i byw- SB0l2s8irli0n5 an mve/Se Sidc)
�h�,, �,. `�. r_ �� I� ._ �l,
6 -/9- 3 � -
�a�d�
Ma�ch 1, aitRttl year
tl ro, whal is his I ner exad share aP i�rest7
m rewe is GRerem Ihan it�at ot ew�t "odimm 6ebw:
mangayee «
d mongapee
Narna of assigrree m m,er rn�x�r a Maer of �B�
Address N asipnee (iwwmbei and sbceL M: sbte, aM LP mdo)
���
year
-oQ�.3s��-o�
unpai0 as W MMpage / Cqniraq
M
��
un{eid a5 d
SOf11B0f1B OUIBf IIWI SC�=B. IfIdYdIB WII�1 WF10111
a���—
r� o��a�
❑ Yes ❑ No
P�PaM � GueLian: Am��y Atsessed
ea� Pruoenr ❑ auneMa�sessm
�G!_A�,vO, ���2J 1�
����y �
D /�-o�5�y�
i
couNn auorroR
Deduclim aVP�'ed'm tlie amouM d
20 �_ 20 _ 20 _ 20 20 _ 20 _ 20
�
sipnature a cwnNnwl�o. cwny oate (mmdn. day. roN)
I I We certiry unda the penalty of perjury t�at ihe above and foregdng information is We and cmrect and tha[ ihe applicant is a resiaenl of Ind"a� anE
owna / mn4aG buyer of �he afarementioned property on date appliration is filed.
Signatu (owimrs fiI1 rianre) Date (rrronN, Eay,
-5-0
FW rasidant address pplicant (n er et. crty, s6Niand Z!P ) �-/
0/2Z a�% � S5�✓1 Z'lv �% 3
Porson aulhwrsed by duly eseaitad Powar d Atto�riay or by IC .1-72-0.7 Date (muYh. Aay, ypar)
nderassd�nnor�aa�� (nvn6araMsLOe;dty,sGte.antlLPmtlo)