HomeMy WebLinkAboutMortgage_Meyer (4)"'n STATEMENT OF MORTGAGE OR CONTRACT II��f�NE� un Tovmship vear
; FOR DEDUCTION FROM ASSESSED VALUATl41N 1 JLJ
Stata Fortn d3709 (R11 / 6-09)
` � P'�'�°�,°e°ar"'���`°°'�"��F�"`� SEP S 201
File Mark
INSTRUCT70NS:
To be filed in rson w b mail with the Coun Auditof or Coun Recorder o/ fhe ooun �' p F� fl� �:
Pe Y �Y �Y N��erethe ' located.
Filirg Dates: 1) Real Property: Must fik dunrg fhe year (or which the deduction is sought �� Counry Auditur
2) Mob�7e / Manufactured Homes rrot assessed as Real Property: M��i���i r�i �Ivq�J'�qapths
before Ma/ch 31 of each year the Ceduction is sot�ht. ❑ Counry Recorder
See reverse side for adtlitional instructions and quali�catbns.
� � `� /
az i'C K¢y number / legal desmp
!
o -z Z _
d rahie d rrdl property as N �C9aBe / Contract inde
1. aaRN year MaRh 1. atmnt year
���
�1 no. what Is his / her e�mU sliare ot inferestt
mU
It name on reootd is OHFerent Nan Nai ol aPP�^L �irate Eelow:
Nartre of rriortgagee or convaG seDU /
�
AAdress of matgagce ar contraq seAer (number and snae4 ciN, sta�, aM
Name of a"�nee or other ownet w holder of rtqrtgage
AACress ot assignee (num0er and sbee; dy, state, aM ZIP cotle)
property in any o�hu I If yes.
❑ Yes ❑ No
the amount oE
20_ � p- � �-
Reco�d number Page nurtibnf
-oa r 3
iness unpaid az d Mongage / Con;raG "uWe unpai0 az d Is Ne aOW�t Me sde
date of aPP�tion legal v equitable amieR
❑ Yes ❑ No
If owned with someorie ather Ihan spouse. indKate wtth M�wn
Is Ihe p�operty in Ouestim: Mnualty AssesuE
_ ❑ Real ProperlY ❑ NmuallYAssesu-0
M1bbile Fiane C 61.1-7
'�� (1�EyE� P,<i-TR_2J� p 'Y
DANa �
I 1-3�05
d�v�v
� -.--' ' - ❑ Yes ❑ No
COUNTVAUDROR
20 _
Counry
20 _ � 20
Dete (rtanN, day, yea�
20 _
I/ We certify u�er Ne penalty of perjury that the above aM foregoing infortnalion is true end cortect and Nat Ne applicant is a resident of IrWiana arW
owner I co tracl buyer of the aforementioned property on date applicatlon is filed.
7renue (o eYS h�+�me) 1 �// Dare (mor+ih, daY. We+)
address of appGrant (iJurq6er antl strec4 dry,
1 ZG �
Pe�son aWm�m.d Dy duly exewted Power o(Aimrney m Cy
stree;
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