HomeMy WebLinkAboutMortgage_Havers�- - ' . . ��.�v�lk l�-�S
�"`" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township �
s'� � FOR DEDUCTION FROM ASSESSED VALUATION y-�
p � v
(� Stas Fo.�n t3709 (Rit / 6-09) �..�.j � y
��„ :'' Presuibed by Department o! Lowl Govemment Finance j� �
LVSTRUCTIGiJS: ark
To 6e (led in pe�son or 6y mail. MAY n'1 Z O� vrm Gled vnth:
Filing Dafes: 7) Real Propert�� M✓st be completed and dated in fhe calendar yea� /or which the deduction �s sought.
h4us( be Iled �t�.h fhe CountyAUdibr w Couny Recorder o; Fhe coun.ry where .he property is loca(ed ❑ Counry Audi;or
on or be;ore January 5 0/ [he immedia(=ly succeeding calendar year. � �/� ❑ Caunty Recorder
. 2J fdobrle /Manufactured Nomes no! assessed as P.eal Proper;y Must file with GheCountyA"udf.' !He' �
county where fhe property is located dunng 1he huelve (72J monfhs 6efo�e Idarchd��rhCy 1�
deduction is sought. � �N7Y A.U91==n
See reverse side for addi;ional ins[.vctions and quali;ica:ions.
Applicant(ownerorronlrac:buye�-seeresMc;ionsonrcrersesi )
SC��� S- �Ciu��i �►�- �t� tit � l-� uPvg
�
Assessed value otreal pnperty as a(
N.arch t,wrten;year
1! no, vrtiat is his ! her e1^ac( sSa�f i;_
r `1
If name on record is LiYeren; ;han ihat of
Name oi r.wrtgzgee or-�n;rzct se0er
number/IegaiEescription Remrtlnu:nber Pagenumber
�W/A— aeo-cba,3�a -o .�o�o
IAlartgage / Conirdct indeb:edness unpaid as ai tdongage / Con•vau indebtedness unpaid as o( Is ihe appfimnt the sole
1Jarc� 1, current year date of xppfication legal or equi;able owneR
I c�1�} �iQ- lU Yes ❑ No'
�� . If o�r:ned wi;h someone oL�er than spouse, indicale vrith whom
pliwnt, indicate beloxa I Is tne property in pu^s;ion: FnnuxltyFSSessed
�Real Property [] MnuallyAssessed
Mobile HomellC o-1_7-7
AdCress ot mortgagee or contracl seller (num5er and sheel, ci.y, s.afe, and Z/P�code�
Name o7 assicnee ar o;her owner o: holCe: of mor,gage
Atltlreis of assisnee (num0er and street, ury. state, and ZIPcW_e)
I Ooes aPplicar.: own property in any oeher I If yes, what munry? VJhat 7axing Districl? 4as Ihis deduceion been requested on pmperry
counry in InGiar.a? I I(or current yeaR
❑ Yes ❑ No _ ❑ Yes n No