HomeMy WebLinkAboutMortgage_Dill"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ - FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / 6-09)
� f Presaibetl by Deparvrern af Loral Govemment Finamx
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INS7RUC710NS:
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To 6e filed in person a by maB wiN the CowtyAuditor or Counry Recorder o/ the county where the property is located. � 009
Filing Dates: 7) Real Pioperty: Musf fJe during fhe year fo� which the deduction is sough[ � Counry Auditor
2) Mo6de / Manufadured Homes rat assessed as Real Property Must fiie dunng the fweNe (12) months `n
bePore March 31 o/each year the deduction is sought .AZ.� �i�J�°�d
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See reverse side for addifionel instnxtbns and qualificat6ons.
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If M, wh3l 6 hi5 / fR! ¢I2G Sh219 Of VIi¢l¢Sl7
m remrtl a�rtrrenf lhan Nat
t rtiartgagee m m�traU seAer
mortgagee or mntraa sdler
Name of assignee or oNU owner or holder af
r/ legal desm , i� n
�i-i aa-
Mwt9aBe / Contract irdehtedness
Mard� 1, wrtent year
Addfess of assignee (numbr.r end sneel, tlry, state.
ctiy, sbte, aM LP code)
as
,oa
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I legal w equeade awnM
❑ Yes ❑ No
with vifwm
�6qR property in 9ueslion: MnuaDY Pssesud
Real PmPeAY ❑ ArmuallY Pssessed
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ca�-�i �io. ....�.Q(�.�.......
DoeS eppliCant ovm property in any OtAer I( yes. what munqR VYhat Taring DistritY� �� '\
muny in InC'ana? � O. 6 lJ
❑ Yes ❑ No _ . __ I