HomeMy WebLinkAboutMortgage_Mackayry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court
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� FOR DEDUCTION FROM ASSESSED VALUATION
:• Stata Fwm G3709 (R71 / 6-09) '
� / Presaibed 6y Department of Lxal Govemment France
�STRUCTIONS: J
To 6e �led in person a 6y mail with !he CounryAUditor or Counry Recorder o! the counry where the pioperty is located.
Filirg Dates: 1) Real Pmperty: Must fJa durirg the year for which the deduc6on is sought.
2) Mo6de /Manufactured Homes rat assessed as Real Property: Must Ae dunng the M1veHe (12) months
6efo�e March 37 of exh year the deducfion is sought.
See reverse side tor addrtionel insVUCtions arrd qual�catrons.
App�m (oivne� or contraC buye� - sP�e re5nc�ass m reve�se s�e) �E
/'
X
o - -� 5 - 00 - 00,
As�sseE ralue d mal poputy as d AUKqage / ContraG "v�tlebtedness unpaid as of
Mamh 1, axrmt ypr Mamh 1, airtem year
K 110. W�18� 6 �16 i�IEI C%3d 5�12R Oi YIiEfCSI.�
It name on recmd is tliRerent ihan Nat of aPP���. �ifate below
Name of mortgagee a
contraG seder (numbar and stree4 uN. sfe[e. aM ZIP code)
w naaer rn rtnrtgage
/+oaress ot assg�ree (numcer ara svee4 �y. s+a+e, am ur coae�
T N cJ is- a-
o� �vd�m a� won�+r �� a�Y am� u y�. �n,:
munryinlrWaw? n .,__ n .,_
20 I 20
Sig�atlueof ryAU`nor ��q �
' l . / / �'0
I I We ce-rtify uMer Ne�penalry o(
owner / contrad 6uyer of ihe afon
AEdress of aWrarsed V��
�_
that the
tt owretl vriN
'f.9�A�
COUNTYAUDROR
- C � D C��� Auditor
� ��CountyRecorder
COUNTY
Reco�d number Page number
�_a a7 a,oll 3J.
! Contrart indebieCress unpaid as d is Ihe apparant the mle
o�Lm legal w eQUitade ame(.�
j ✓ S �S ❑ Yes ❑ No
�ne Ntrer ihan sPW�, md�te wiM whom
h iM ProPenY in pues5on: MnuaM Pssesse0
❑ Real Fnaenv � amua�N assessed
Mobile Fionu, QC 61.1-i
:/1 � I I
53a�
�—j j, 55 S� c�D
0
20 _ 20 2(1 20
Counry Date (monlh, day. Yea�
nd toregoing infwmation is true and correct a� Mat Ne applicant is a residerrt of IMiana aM
date application is filed.
Dare (nmfh. day. Ma�
m��beda�stJreet. rity, fe, antl ZIP/ code)
'6/C'KC. �IrACPTOn.
Power of AllcmeY or by IC G7.1-12-0.7
YeraM sbee4 ary. sbte, and ZIP mtle)
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