HomeMy WebLinkAboutMortgage_Pressley""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
___ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R11 / 6-09)
�' ° PresaibeE by �epartment af Local GovemmeM France
File Mark
wsrRUCnoNS:
To be filed in person a by mail with the CounryAWifor or Counry Recorder of Ne county where the property is located.
F�Nrg Dates: 1J Real Property: Must file during the year /or whicA Ma deducfion is sought.
2) Mobde / Manufactured Homes rrot assessed as Real Property: Must fi7e dunrq the twehre (12) rtwnfhs
6efae March 37 of each year Ne deduction is swgM.
See reverse side for additional instnxUons arM qualificalrons. G
Ap�Wwneroroontractbuyw^seeresfiUOns�verseside) i1i . .
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If nart�e
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�wmCer / legal desaiption - ' // R¢toiA num6er Page numbu
- - -yDb-DDO.S D-��oa7 0/� 07
paperty as d Mor�qage / Contrau intle6ted�s unpaid as o( Martgage / Cmtran'vNe6te�s unDeid az o( Is tAe eOW�t Ue sde
Mard� 1 wrtent year date of aPP��� � a M���� �n
1 I a o 0 0 ❑ Yes ❑ No
ezaG shafe of intemst? If avmed wiN sdneone dher �han spouse, indwate with whom
iRem�t Nan ihat of aDP�'�C trMUam Gelow. Is ProPertY in QueYion: Mm�aM AssesuE
[�R¢21 PfOPCIt�' ❑ M!LLi211yAsse�ed . . _
Name W nartc�ajee a mntrad se0er
�Q.��/ �- �
Addres W rtnr[gag� or contraU sWer (numbe� ard svee4 �dy. state. aM ZIP mde)
Name of assignee or other owner or hdder of nqrtgage
AdCress o/ assigneg (^ �qq7 stree4 ury, slale, and ZIP�co e), •
Ooes applimnt own ryoperty in any oNer
��uy �� i�ae�aa
❑ Yes ❑ No
Drduction approu�,-0 in Ihe amount ot
20 20 _
Sigtahrte of CAUnN Auditor_
II yes. �Mal muM/1 ( What Ta�
COUNN AUDROR
20 20
i/ We certify under the penalry of pe�yfy that ihe
owner / wnVacl buyer of the aforementioned pro
resieenf address W appfimnt
slete,
Dra�ti�er \TO..�01.�.........
C�1'C� 1`�. ..��..1........
► �a,�.�
20 � 20 � 20
ICounry I Date (monN. daY• Y��
ntl foregoing infortnalion is We and mrtect arW tha[ the applipnt is a resideni of IrWiana arM
date applicalion is filed.
Date (monM, day, yva�
��
Pdtlress of aWror"ved person (num6er aiM stree; ciry, s+ate. antl ZIP oode)