HomeMy WebLinkAboutMortgage_Lamey (8)'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ = FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Fwm 43709 (R71 / 6-09)
� � Presaibe0 by DeP��N af Lod Govemrtrent Fuiance -
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INSTRUCTIONS:
To be fileC in person w by mail with the CountyAuditor or Counry Recofder of the co�nry where the property is locat .
FrTirg Dates: 1) Real Property: Must file durirg the year /or which the deductmn is sought
2) Mo6i7e / Manufactured Fbmes rrot assessed as Real Property: Must fiie during the tweNe (12) months
6e(ore March 37 of each yeer Ihe deduclion is sought.
See reverse side 7a additional inst�uctbns aM�lificateons.
�Mofaa�nlowneioroontrdcl6uYer-S/ere5_' ' stle) � n
f ra4c U real P�P�Y %z
aimrt y�
ro, �t
rwne m
Name of mrtgagea or mntran seller
Addrea of rt�ortqagee ar contraU se�
Name W assssignnee w otha ownu or t
Adtlress U assi�ee (nurtNer end sm
enyother
Yes
' � V i.%� (J�
Mwyag e/ Contraa inde6cedness unpaid az of
Ma� 1, a�rent yeer
Ir owrn
�t Ldira9a Eeluw.
O�
eM sbeel �y. smte. eM LP coda)
�e /.aS�AG '
No
tt yes. what munt� � Whaf Tadng D'Nri�?
DeCumon apprwed h tlb 2m0uN at.
20 20 � 20 2^�—
SignaLae ot Camh Autlimr Caunry
I I Wa certi(y unCer Ne penalty of perjury that Ne above arW foregaing infwmalion is We anc
owner I mntract buyer of the�xementioned property on date apPliption is filed.
fWl entaddresso(appfimnt(number�
//S 5 O S �S o
Person aWw�C Gy duty ezewtetl Powv
AddresadaWwvsdpersan (num0ererc
state,
ury, uafe, andLPCOde)
indebtednass
oO.�
i�) 1 (1
nwn0er
7/0
a epu�mde ownert
❑ Yes ❑ No
V�cen`/ in VuesUOn: MrweM AssesseE
e�ao�ny ❑.nro,u�nyw�sea
tlas ih¢ deduSOn Eeen requesteE m p(apeny
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