HomeMy WebLinkAboutMortgage_Rainey"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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; FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Fwm A3709 (R71 / 6-09)
�' ,.,. 1 Presvibed by DepaNneM o1 Lmal GovemmeM Fnance
�STRUCTIONS: w�
o be fiied in person or by mai( with the CounfyAuditor or Counry Recorder ot the counry where the property is located. � � L V ��
F�irg Dates: i) Real Property: Musf file durirg Ne year (o� whicA the deduction is wught � Counry Auditor
2) Mo6�7e /Manulactured Hanes rwt assessed as Real P�operty: Must h7e dunig the nvelve (72) months C.
before Ma�ch 31 0l eacA year the deduclion is sought b R�b�
See reverse siCe /or addifional instrucGons arM quali�cations. G IBSON C
P.p ar vyer- see �estricnais rse side)
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Tavng Key rwmber / 1¢gal desaiption Record num6er Page numGu
a-�*�� - a-o �� -oa o y �lg
_' A�sed vaNe oF real propeY,y as d A/orlQage / Contraa'uWe6te0ness unpaiE as of Mortgage / Cantral2 ifWebteeemss unpaid as Is Ne applxant Ne sde _
If M, Wh2I15 hi5 / h¢f ¢%2f2 Shdf¢ 0( VISCRSf?
If rwne on reco�d is QAferrnt Nan Nat o1 appGCani, i�M'uate Delow.
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Name of mortg w mn se0er �J
��J(j!� OAA ` /.�/Y7.1.0'�
Address G mortgageE or contrad seller (nurtiber end svael, city, stefe, erd i
Name W assignee or other awner or halder of mortga9e
AdCress ot assignee (number aiM svee4 city. s+ete, antl Z/P coCe)
Does appfinnt own poparty in any olhu If yes. whel munq?
ca,� �� �a�a�a
, n ❑ Yes ❑ No
2o I 2o I zo I 20
NTaI Taatg D'Sma r
20
❑ Yes ❑ No
SPOIISE,
�:ea� Prov�v ❑
Dra�ver NO.... °2�� �.
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io� �;i �en
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zo zo
Sigreme d Coimry Aueitor I Caunry I Date (rrmlh. daY. Y��
I/ We certify under Ne penalry of perjury that the above arW (oregoing infortnalion is We and correct aM that the applipnt is a resident of India� and
owner I contract Wiyer of the aforementioned prop on date application is filed.
S�q�LUe (o fiA rertre) Date (monfh. daY, la�
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Fu0 mide�atldrass of appGmnt (numDe� an0 sheet aN, �+e, antl LP ootle) � � ��� �
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Person au0io�rzeE Dy OWy exewcetl Power dAtlomeY a M IC 61.1-1 -0.7 Date (mmM. day, }ea�
Address of auTha'ved person (number arM sbee; rlry, stale, and LP cotle) .