HomeMy WebLinkAboutMortgage_Pheral^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou o n i ear
r__,_ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R71 / 6-09)
��.r � Presaibetl by DePartmeM of Loral Govemmenl F�nce � A
� ile Mark
wsrRUCnoNS:
To be filed in person or by maii with (he CountyAuditw or Counry RecoNer of the oounry whe2 the property is located. F� ^ v
Filirg Dates: 7) Real Properry: Must fife durirg the }rear (or whicA the deduction is sought. �
2) Mobile /Manufactured Homes rat assessed as Real Property Must file dunng the hvelve (72) montHbIBSO C�NT�%, i�i
before March 31 of each year the deduction is sought Q Counry Recorder
See 2verse side !or additional instniUions and quali�cations. _
0
w�a � �r� �eny as w
Mairh 1, ament yr.v
no, what is his / her e�act share o( interesi?
It name m re�nrG a dirterent Nan Nat of appGcani. indica[e 6ebw
Name W mw��agee ar mnVact Shcer I/
O N. �
AOd2s5 U^nrt[]a9ee v contraa seUer (numbv,r and sbeeL �a): 5fate,
rvame rn assgnee w omer owner or imuer o� rtrortgage
noaress or assgnee �numoer ana suee4 �+ry. s+are, arw ur cooe7
own yoperty in any dher � If yes. whal
DeducUOn apprwed'm ihe amount ot
20
Sigreture af Camry AuEitor
20 � 20_
-��.dy�-
sarneorie
RecarO numbel Page number
�i �.� �
unpad as of Is Me aDP�t Ne sde
legal w eQU'rtade ox+�eR
� Yes ❑ No
spouse.
Is Me propetty in qur..UOn: MnuaDyhsse55ed
� Real ProPeKY ❑ �^�Y �
Modle I-lort�e IIC 6
pµ�a� �s���.
mu.�a�a�� 2
�'
GOUNN AUOR�
20 20
Counry
li-L3al� �
�
20 20 _
Date (rtaNh. tlaY. Y��
I/ We certrfy under U1e penalry of per�ury Mat the above aM foregoing information is W e and cortect and that the appli('ant i5 a re5ident o( IrWiana aM
owner / mntract buyer ot Ne aforementioned property on da[e apd��tion is filed.
Full resitlent aEdr�ss of eppluant (number aM street, dry, state, antl Z/P ootle)
� ia S 7 L•"� O� PL•'rTE"KS (f v Rv R 0.
Person autlronzed Gy duly exewted Power o(Attm�ey or by IC 61.1-12-0.7
state,
'�-rv-iv.v ,r,✓ y?G7CJ
' Date (rtanlh. tlaY,