HomeMy WebLinkAboutMortgage_Esareyk
"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni
:. _—
+ FOR DEDUCTION FROM ASSESSED VALUATION
.• Stale Wrtn 43709 (R71 / 6-09)
� '� PRSfiiEeE by DePartmeM o( LoCal GovBmmeM Firenca
�«.
INSTRUCTIONS:
To be filed in person w by mail with the CountyAudifor or Counry Recorder of the counry where the property is located.
F7ing Dates:. 1J Real Pmperry: Must file dum�g the year Por which the deductlon is soughf.
2) Mo6de /Manulactuied Homes not assessed as Real Property Must ne dunng the twelve (12J months
6efore March 37 of each year the deduclion is sought.
See reverse side Ior addilional instiucUons arnl qual�wtions.
Fmn fded with:
J N � �a,e�m�
n ��.,..CounN Recorder
nppGCam( �oroontr�actbuyEr)-seere.u�icriuruonreversaside) 16SUNCOUNTYAUDITOR
a�/ a� �m •
T ng istrict Key number / legal aesaiption Reoortl numbel Page numbu
a<o - i - 3�{- Yov_ oo�. � 8-o a-S� �0 7 Y3
ralue d re� {aoperty as W Mo�qa9e / ConvaC intlehtetlrress unpaid as o( MoRgage I Con;rari'vMe6teCness unpaid as d Is Ne applkant Me sole
1, qa�an yrar Mamh 7, artent yrar date ot appLcation legal or epuitaWe avme(?
If ro. whal
11 �ame on
�'ame N rtrongagee or mntraG seller
Address ot morcgagce «mntran sell
Name ot assignee w oiher owner or Y
li�nt own poperty in any oiher
Intliana? ❑ Yes
Daduction approved'o� tl�e amount
mtlitate belrnr.
vata,
ary, srare, ano ur cooe)
n res. �+�ac m�my�
❑ No
20 _ I 20 I 20
Sigiawre of Counry Auaitor
G . T. �v���
I/ We certify under Ue penalry of p'ury that the
owner I contract buyer of the aforementioned pr�
Pelsan
oF
state,
person (numbera�M sbeef, dry, stata,
��' � ❑ Yes ❑ No
tt owned wiN someorre oth Ihan spouse. iMifate wiN xMm
Is roperty in Question: Mrn�aOy Assessed
[�Real ProPeM ❑ A^^�Y �
Rbhle Flort�e (IC 61.1-i
s6 j
�
�,-�,�-�,. ,�o.. a r(�, a .
.....
Ca rd 1\'O. ... � / � �
� l � V' IJIJ� • � . . . . . . . . . .
_ 20 _ 20 _ 20 _ 20 _
Counry Dale (rtmfh. daY.1��
e arW foregoing infortnalion is We and cortect arM that Ne applirant is a resident of IrM'qna aM
on date apPlication is filed.
Date (nmRt daY. Yea�
71
Date (monrh.