HomeMy WebLinkAboutMortgage_Schmidt'°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
_. FOR DEDUCTION FROM ASSESSED VALUATION �
Spte Fortn d3709 (R11 / 6-09) n �
�,,,. � PreStriEed Ey DepartmeM N LoW Govemment Firtvice r, V
f '�V \ Fle Mark
INSTRUCTIONS: �
Fam fileO wiM:
To be fifed in person w 6y mail with the CountyAUddor or Counry Recnrder o/ fhe oounty where the pioperty is laated.
Fdhg Dates: 1) Real Pmpeily: Must file dunrg the year for which Na deduclion is mught � Counry Auditnr
2) Mo6Ae /Manufactured Hanes not assessed as Real Properly: Mus7 file dunng the hveHe (72) mrnNs
bePore March 31 0! each year the deducfion a sought ❑ �^h R�O��
See /everse side for adtlifional instrucfions araf qualifications.
APP�1(owner m owvraU �ryer. see ie�j�n'ons m reverse side) �1 . .
Key number / kgal deso�tion
a�e-a3-a�-aoy-000•�8�-oa-
�f mal papMy at d �ge / Con2raC'udehteE�a unPaid as d Mortgage I Contr�
�. year Me 1. wrtent ye9r tlate W eAP��
a �r � �- S �
u
W rtprtgagee or cmtrxt se0er
r�
� ,
Name at assignee w ahel awner w hdder of morv
AEd2ss� (� antl et, �; �te,
Does eDd� wm D�DeM1Y in any oNu
�� � ���� ❑ Y�
❑ No
���,�����«:
�
�(ature d Co�mb Audimr
i / We certiy u(W
ownerlcontraU ye
7 (o�merS hd imm�
0 ' en��
3a-a C . .{
� � �
cdy, 5ate, aM
tle�- Sp_� ,_
.1c.C. 4���
whatmunt�/1 WhetTa�dn(
20
P
Recad numbri
ao ��
�
sva+se. "udicate uith wham
S! 9 �
�t�,a�
rita6le o�v�xl7
Yes ❑ No
propeny in QuesGm: MnuaOy Aswssed
�I Property ❑ Mnua�ly A�ssed
� a�i �, �-SO, �
a��°
r � �Z
�C..� � I.........� .
penalty of perj Ihat the above arW foregoing intortnatlon is We and cortecf en� that me a,,pli�a� �t is a resMent ot i��awa antl
of the aforemen0oned property on date application is fiied.
� o n i' ��e t�. �r, r�h
r
antl sfree4 �:
,•-�
person (numbe� antl sfree; riry, sfa[e, antl ZIP mde)