HomeMy WebLinkAboutMortgage_Scheller (3)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tavmship vear
_. ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
�' �«. � PresQibeE by Deparvnerrt of Local Govemment Firenca
F
INSTRUCTIONS: y�,�
To 6e filed in person a by mail witlr the CounryAuditor or Counry Recorder of the counry where the property is located. F I ��� Z Q 10
Fil'mg Dates: 1) Real Pmperty: Must file during the year /or which the deduction is sought. �� Counry Auditor
2) MobAe / Manulactured Homes nof assessed as Real Property: Must file during fhe tweNe (72) months
before March 31 of each year the deduction is sought Coun Rewrder
See reverse side /nr additronal insVUCtions arxl qualifiwfions.
! �
ralue U m�al poperty as o(
1. arm¢ year
rc no, wha� fs Ns � hu eYar2 share ot inteiestl
It rurtie m remtl a SAfemnt Nan that of app6ranf,'uM�te Cebrc
r�a�e or �rortaasee a �rar� �ne� � I
Addres of nnrtgagee «mntraa seDer ------' a�wL c�N, smm.
Name at assignee w oNU owner or M
Adaress ot assig�ree (num6er and stre
Does applipnt wm property in any ol
munry in IMana?
❑ Yes
���1.
sanieo�
Remrd
unpaM az of
ves u No
Is tl�e 7mPen1' in OuesOOn: MmiieOY Aacs.�W
� Real Plopefty � Amlually 0.sses5ed
e�on�x � nc �
DI'A1YC1- i�'0... �ID
_ .....
C � �-U (�� O. ...�� V ' J¢tnC? Nas Nis tleCUUim Ecen reQUested on P�Y
� ll (I UV� ..••.•••.• fara'ren�YeaR � Yes ❑ I
c0an app�wea c� Ihe amount ot
20 20 20 20 20 20 20
I/ We certify urWel Ne penalty of perjury that the above arW foregning infortnation is W e and cortect arW that the applitant is a resident of IrWiaria arci
owner! contrad buyer of the atoreme�nedproperty on date application is filed.
i�aave (owne�'y11�me) _ _/1 � i Date (�. EaY, yseA
O�,S/ ,� /Oa2SS ,�,�sv�iS/
autlro�d Oy dury esewteG Power of Attort�ey or Cy IC 67.1-12-0.7
persan (number arM sbee; ciry, state, antl
76
Date (monN. tlaY. Yee�