HomeMy WebLinkAboutMortgage_Cederholm_^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
, FOR DEDUCTION FROM ASSESSED VALUATION
Stafa Fwm 43709 (R71 / 6-09)
�' Prewibe0 by DepertmeM of Loral Govemrtrent Flrence
INSTRUCTIONS:
To 6e filed in person w 6y mad wffh the CountyAuditor or Counry Recade� ot Me rounty where the pmperty is located.
Fi6rg Dates: 1) Real Property: Must file dunrg the year fo� which the deduction is sougAf.
2J Mobde /Manufactured Homes rat assessed as Real Property: Must file d�nng the lwelve (72) rtronths
6etae Ma/ch 31 0/ each year the deduction is so�gh.t.
See reverse side 7a addifiona/ instructfons arM qual'dicafions. „
A� value d� proprlty �s d
nfard, �, arrenc year
tt no, what's Itis / her e�a share o1 intrlest?
tt �wne m reaad is ?MnJmt Nan tlat af app!
�% ��/%�%
�er/ ald '
� aQ � ���. /��� �
��e/ Contra�Y'ude6ted�s unpaitl as d Mortgage I ContraG i
. a�M y�. ear� ar �a��+
rc �e �;m �meo� ane� n
Year
D[� }, �° untyquditor
E�" Counry R �e aeu
U��
unCaid as af L
oreputtaa
❑ Yes
� propelly in Guesbon: MmieAy Assessed
Real PmPenY ❑ %��Y �
No
Name m rtnrtgagee or mntraU seuer ��/C� // / � � / / /
)��n� / /
X�f�,,/ /
Add2a d rtnrtga9ce a contrad seAer (n�rri6cr end ciry, sbte�nd LP cod
Name of assigiee or aher owner w hdder of mortgage
AdEress oi assigfree (number an0 slree4 �: state, and LP code) ,
Dces e�itant own property in any oNer If yes. what count�/.� —'...^. -_._ Nas Nis deduCim Oeen requested m P�Y
cou�LLymind'ara? ❑ Ye5 ❑ No _ _ C�Q�1„1�OL m''.••�n_--n-Yes ❑ Ni
GOUNTY . T�}J (}J
D�uction approred in ihe amoum oF. /y� {-� � �
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�_ �_ �_ 2o_ aoio s8�� �°
sg�an,R w caa,a•�•�art« I..,,., , I =a�
I I We certity uMer ihe penalty of perjury Nat ihe above arW foregoing intortnation is We and mrtect a� that Me applipnt is a resident of I�iana and
owner I mntracl6uyer oi the aforemeMioned property on date applicaGOn is filed.
-/ Sg knerznmiame) /
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\, • rnsitlem ad�ess of aPP�� (number antl sbeet, cdy, sta:e. eM ZIP m
��� �/� E ,CoL l �/
Peson autlp�rzed Cy Mdy exea;ed F'ower a(Attamey or by IC F7.1-12-0.7
Pddress W autha've� person (number antl snee; dry, state, entl LP mde)
v 4 7k 7 v
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