HomeMy WebLinkAboutMortgage_Ziliak"'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co s P r
_„ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 63709 (R71 / 6-09)
,' „r PreSaiEeC q' DePartrt�e�rt of Local Govemment FinsrKe
wsraucnoNS: '� '� 'LUIU
Fmn tded wiN:
To be filed in perxn or by mad with the County Audhor or Counry Recorder o� the county wfiera fhe property is bcated-
Filirg Dafes: i) Real Property M�st file durrrg the year (or whicA Ne deduction is sought C�Qn�iud'ROr
2� Mo6de / Manulactumd Homes not assessed as Real Property Must file dunng Ne tweMe (12J months �r_�� /."
6e(ore March 31 ot each year the deducbon is saghc �� �yn'AR�Q�Q, 5R
See reverse side foradditional instrtictions and qual�cations. G�B
I Apqrcany(oyr qr or mitr�t buyer - see resvcnms m re�er3e sile) �^ � • i1
_.°_.___ r .. _ .-_ _ __ . _.,_ ____ , _ -
- a. - Do -p p0 .`-f 5'b - v o1 a-o 0 9 (o
vaLe d real v�op�tv a a Abrtpaea � conuaa 4,aecteaness u�aab as or Mongage � c«iract maee.eaness una�d as d �s me aoa�t u,e sole
MaM� 1, anP�li ytlr Me�di 1, wr2nt ytar aate of appiiration legal «eQuitable owne(.�
a0D QQ ❑Yes ❑No
tt ro, whal'o tus / her rra�Y shara ol intrlest? If ow�ne0 wiN someorie oUrer Ihan spouse, udi�te wiN whom
If rurtre m famd'o d�tte2nl Nan Nat of aPpOcanl, Ind'uate DeWw.
rUrtre ot ma+6avee «conaaa
�a
streeL �1: stem. arN LP code)
mttigage
Pdtlress ol asagnm (number ard shee4 mY, s+ale. eM LP�dT �
Y�
Oces epptirant own pmperty in any oNer If yns. whal coun
munryinlnd'ana? fl .,__ 1-'I .�_
amount
sE �4_y_
:�Z�IIP.YILDl�]YL•]:i
20 _ 20 20 _ 20 _ 20 _
Sigrenae d Camb Auditw Couny
/I I We certHy under tha pen of perjury that Ihe abo aM toregoing infortnation is W e antl a
owner I mntraG buyer oF Ne aforementioned prope on date appiiration is filed.
k �'�",e�. '��%h,� /,���-
s of appfxant (flumber antl sLee4 ti�; sfet°.
y� w ��-r'j o S �
�y duy ezecured Power of Attm�ey rn by IC 1
Pdtlress of auNorrsed person (numbera�M smee4 �y. sbte, and ZIP mde)
�Is Ne rty in Question: MnuaOyASSesseO
�xm ❑��r�
a�oax ra,� nc 6
/ • 5 ,�} c.
NaSlha dedumm Deen re9uested m P�Y
rw w�n rean n.,_ _ n,
UI'115'C'1" 1��0.. oZi� 09
Card NO. ..i0,3.�/,
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