HomeMy WebLinkAboutMortgage_Bracher^�� STATEMENT OF MORTGAGE OR CONTRACT INDE
__, � FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fmm 43709 (R11 / 6-09)
�,�,� � PresoibeE Gy DeV��nt of Local GoremmeM Frence
Coun Township Year
I@
(�srRUCnoNS:
�4�w 6e filed in person w 6y mail wifh Ne Counry Auditw or Counry Recader of the counry where the pioperty is located.
Filing Dates: i) Real Property: Must file dun�g the year /o� which Ihe deduction is soughf.
2) Mobde / Manufactured Hanes not assessed as Real Property Must file dunng the hveNe (12J months
6efore March 37 0! each year Ne deduction is sought.
See reverse side for add"rtional instnictions and qualifx:ations.
npp&am (owner wmntracr buyqr� see m..wicnons m reverse side)
' 'm�'
no. what is his / her eraU sl�are of interesi?
� / Contraa'uWebtetlness unpaid as N
ammmt yrar
11 name on recatl is Eillerent Nan Nat of applimnt'uWicate Oeb�r.
Name o� rtnr[gagee or mntmd
w cantract seller (numb�v aM streef. cRy, uate, aM
of assi9nee or other owner or IMder of rtnrtgage
ACtlmss ot atignce (number aM stree4 �Y. sfate, and ZIP code)
If awned vriN someone other than spouse.
C.j�_�
I LJ
L—
iON COUNI
Rerad num0er
unpaitl as d I
Caunry Auditnr
CodntY Recorder
h Me OroP�Y in Vuestim: Mmt
�'Real PruPeKY ❑ � e
� 6 132Ac�� E 2.
/ (� ` � l.C� /
Page num0al
Yes L) No
IDoes appliqnt oxn property in anY oNer I If yas. what counry? ied on property I
munryinlMana? r-i . r-i . I-1 .