HomeMy WebLinkAboutMortgage_Potts (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u sn vear
_ , FOR DEDUCTION FROM ASSESSED VALUATION � /
� State Farm 43709IR71 / &09) v
� rr Prnsm'beE M Depertrt�rC of Local Govemrt�e�rt Fvarcn
N�V $File��y
INSTRUCnONS: F� q� �.
b be l3ed in person w by mail wr[h the CountyAuditor or Counry Recorder o/ Ne county where fhe properry is lacated.
Fitirg Dates: i) Real Property: Must 91e durrng the ysar (w which the deduction is wught `�-y� -' CouMy Aud'rtor
2) Mo6�7a /Manufacfured Homes rat assessed as Real Properfy Must h7e dunng the hvefve (12) montha� "� s in�� R��
6efae March 31 o/each yea� Ne deduction is muqht.
GIBSON C UN AU�ITOR
See reverse side for additionel inshuctlons and qualr(cafions.
Mv�nt(cr*ie/arcm9$tbuyer-xe , mrj%usesiie)
mS{C vah�e af mal paperq
BIf�i7 WItIG�/P'd!
ro� what is his / frer e�ma sh
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� co�traa �em�
wfRIR yP.Br
rartn m temt7 "s Citla2nt tnan that N aOP�: hNipm 6elv�c
r+ame at �r�agee m m�van xu«
PdOress af nnrcgagex ar mntraG
tdy, state.—eM LP code)
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tt ovmed with xomeorre athrs than
couNn nuorroa
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Caunry A
ler the pen� of perjury that the above ard foregoing mfortnation
buyer of th afaementioned property on dete appfication is filed.
F en[ address of applicant1� mDar and sbaet �: ��. a�q LP m�
/ /�36 � -S• b/ea,�l/!C tJ �7-. _ ,
P� e� � a� ��,� � o� � a� �� �,.,-, z�.�
Address of aulhar'¢etl 7� (numbe�an0 sveeL �l: �ta. aM LP wde)
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ves u r+o
Is tl�e pfoPeRY in 7urstion: MmiaM Assessed
❑ Real RoPeRY ❑ ��'�
a�on�� r� nc s
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and cortea and that the appluant is a residerrt
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