HomeMy WebLinkAboutMortgage_Murray"�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Townsnip vear
__ ,� FOR DEDUCTION FROM ASSESSED VALUATION
• Stata Form 43709 (R71 ! fr09)
� � Presvibed by Depanment of Lo�al Govemrtrent Firanca
�" File Mark
srRUCnoNS: MAR 1 0 �„
To 6e filed in person or by mail wi[h the CounryAuditor or Counry Recorder of the counry where the propeRy is located.
FiI"vg Dates: 7) Real PropeRy: Must file during the yrear Por which the deduction is soughL C.'J. Counry Aud"rtor
2) Mobde / ManuFadured Homes rat assessed es Real Properfy Must file dunrrg the tweNe (12) months
before March 37 of each year the deduction is saghG Counry Recorder
See reverse side !or edditionel instiucGOns and qualifications. G I BSON C OU
Appfrant(pxneraroontraCbu}�r-seere.Vnraonsu'Lreuersestlel Y .-._
Key number I legal desaiplim
-�J �� �� 3 -/� - 3oo-oc
ppp¢r(y ¢y pf MoRqage / Contract irdehtedness unpaiE as o(
Mart�h 1, wrtent year
I( ro, what a ha / her ezaG share of intrlest?
If rwrie on recad is E'iRernn[ Nan that af aPP��t'u�Airate bebw
Nartre of rtnrtgagea v cmtraU seDer 7 �
Address
sWer (numbe� and snaef, crty, state,
Name of assignea w other awner w hdder of morcgage
Address o( as99nce (numbu and street �Y. �=e, and ZIP code)
��.e�-� 7 3 � /
Dces appliGnt own poperty in any oNer It yes. what
cwnryinlMena? ❑ Ye5 ❑ No
o��c� avv� m ure ama,m or.
20 _ 20 _ 20 _
Sigreture W CounNAUdibt
I/ We certify under ihe penalry of pLlrjury that
owner I wntract buVer of the afwementioned
F em a0tl�¢s of appGr�nt numb r/� stare. a
�1`��� c `a ti n
Person autirorved by duy ezewte0 Power of Attomey w by IC 6
PGdress of a�nhu'veO person (�umber aid svee4 ciN. sbte, and
7S�- o
cgage / Contract inEebtedne'ss impaid as d is Ihe appfi�ant the sde
r of ap0utation r.� p L legal a epuiiade ovme(.�
I{ p � Q T� ❑ Yes ❑ No
someone oNU Ihan soouse. indkate wiN whom
� �
w�c r�q o
2�
Is Ihe property in V��estion: MmiaDY Assessed
❑ Real Propenv O /vmuaM asse��
IMhile Fbrt�e fIC 61.
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Dra�vcr \0........
Card NO. ...10.3� CJ ........
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— , �— i �
Data (mon�n.
aM foregoing infortnation is true and correct arM that Ne appli�ant is a resident of IMia� aM
n date appliption is filed.
Date (monfh. daY. Y��
7
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