HomeMy WebLinkAboutMortgage_Miles^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun o shi
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� FOR DEDUCTION FROM ASSESSED VALUATION
� SUte Fartn 43709 (R71 / 6-09)
�' � Presaibetl by Oepartmerd of Loral CovertuneM Fuance
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uvsrRUCnoNS:
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To 6e filed in person w by mail with Ihe CounryAuditw or Counry Recorder of Ihe counry whe2 the pioperty is located.
Fil'mg Dates: 1) Real Pmperty: Must file dunng fhe year /or which the deduction is saughL Cpun " t
2) Mo6i/e / ManNacNred Homes rrot assessed as Real PmpeRy Must fiie dunrrg the IweNe (12) months GIB O OU J(�T�'. AlJ ��
before March 37 0! each year the deduction is sought �Y �
See reverse side tor addiCanal insVuUions and qualifications.
App&an r oontraC/ �6uyer- e resfnctions on reverse " e)
�'Y" �
Key number / legal desrnption RecoN num0er P e um
� _ r- Qo -ooa. a i-aa sL �'
raWe et rnal property as of Mor(qage / Conbact intlebtedness unpaid as of Mortgaga / ContraU mde6tedness unpaid as M Is Ne epplifant Ne sole
�AarU 7, amvrt yrar Mamh 1, airtent year tlate of ph kgal q eawtahle avmel.�
pZ ❑ Yes ❑ No
Ii ro. what is his / her eza�l share ot interest? If ownad with someone other ihan spouse. indicete with wMm
If fwrie m mmN's tlitFerent ihan lhat of aPP����. �ipte bebw. Is the property in puestion: Mnue�y Assessed
eal Property ❑ MnualyAssessed
� MoWle Hane IC 61.1-7)
Nartre of mort9a9� or mntrarl seller
A4dress of nart9agce w mntrad se0er (numbrl aM stree� rdy, sta:e, arrd Z/P code)
Name of �ee w oNer owner or holder of mort�age _ �
�3 0�3
AECress of assignee (number ard shee4 my. sbte, and ZIP code)
pces applir2N orm property in any oNer If yes, what munt�R VJhat Taprg Distrirl? Has Uis AeOUCian Oeen requested m p�opcly
oounry in trdena7 ❑ Yes ❑ No � Q�� � ❑ Yes ❑ Nn_
COUNTYAUDROR
DeducGM app`wed'o� Ihe artauN oE
2q 20 20 20 20 __-- � C
Sg�wredCamtYAUeitw CaunN 1' ���JJ u�j {� �
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I I We certify under the penalry oi perjury that the above arW (oregoing infomia�ion is We and cortect: j � SN�
owner / mntrad buyer of the afo2mentioned property on date appliralion is filed. I I
Signanire (owners h� name) �
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' F/% ��t aGdress W appGrant (number antl s4ee[, dry; sbte. aM��//�.� //' / !�� ��
X CL�•QfJL // w.� l! J V
Pason aurt�arzeC by dWy exeatetl Povnx of Attm�eY w Cy IC G7.1-12-0.7 �e (^b^W, �Y• Y��
Pdtlmss of aNhoraeE persrn (numberaM sbee4 �Y. s+afe. and LPmtle) .