HomeMy WebLinkAboutMortgage_Maxam"'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ � FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fwm d3709 (Ri 7/ 609)
i,.,. � Presoi6ed by DepaNneN al Lad Govemment Finamx y
INSTRUCTIONS:
To be filed in person w by mail with (he CounryAuditor or Counry Recorder o( fhe county where !he properry is bcated.
Filmg Dates: 1) Real Property: Must file dunrg the year7or which the deduction is sought.
2) Mobde / Manulactured Homes rrot assessed as Real Properfy: Must file during fhe hveNe (12) months
6etwe March 37 0/ each year Ne deduction is sought.
See revers side (or addiWnal inshuclions arM quali�ications.
i AppGrant (o r w contract buye� - see ie9rction� jgverse sida) w �n..
1'�'.U'I
rc�o.�is�ir�e�sn�or��,esn •
If name m Rmfd's diffuent than tltat o! app9cani, uid'uate belmr.
Nartre af rtnrtgagea w crntracl se0er
Address of nartgagre w wntract seA�
Name of assiunee or oNer awner or h
of mortgage
nnoress or asvgnea �numoer arn anee; wy, srere, ana u�
Dces epplipnt own p(operty in any oNer If �
munry in IMana?
❑ Yes ❑ No
County Recorder
� • OL li `/
intlebtetlness unpaid as of Mwtgage I Contract'uWeMedness unptid as ol Is Ihe eppl'uant ihe sole
tlate af appGcation kgal or eQURade mmM
O O ❑ Yes ❑ No
ff awned vriN sameone dher than spouu. indwste wuh whom
Is Me woPenY in auestion: MnuaOy Assessed
❑ Real ProPenY � ��Y�
Afobile I-brt�e !IC G7.7-�
city, slate. aM LP rodl)
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Draiti.e►iY\i0 0 R
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C.'� i��i 1�rO. .. a 3. J` l ductim Eeen O YeS� v❑ I
.5-�....... YraY�
20 20 20 _ 20 _ 20 20 20 _
�nahrte W Counry Auditor Caunry Date (nmth. daY. Y��
I/ We certify urWer Ne penatty of perjury thal the above aM (oregoing intortnaUon is W e and correct arM that the appiinnt is a resident of Ircllana antl
r! mnVact buyer of the aforemertlioned property on date applicatlon is filed.
(owxrs !u0 reme) Date (manfi. daY• Yaah
. IA.�-. �%d-`�'�-�----'
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ss o! nt (number and�f, a'ry �
. `
Q N
oy amr e=ea�uw ao�.er ornunner « M i
Ed pe�son (numberaM sfree; dry, slafe.
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