HomeMy WebLinkAboutMortgage_Shoulders"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip Y r
__ _• FOR DEDUC710N FROM ASSESSED VALUATION �
� State Fwm 43709IR17 / 6-09)
�' ,�„ � Presoibed by DepaM1meM of Local Governmenl Firence
009
wsrRUCnoNS:
Form Aed wiih:
To be (led in person w by mail with the CountyAUditor or Counry Recorder of the county wheie the pioperty is located. ��� j��
Fiflng Dates: 1J Real Property Must fAe durirg the year (or which the deduction is soughL �f�� ����� j�j/p�pr
2) Mn6ile / Manufactured Homes iwt assessed as Real Property Mus! file dunng fhe fweNe (12J months ({ I 96 G��7.0 ��
before March 37 0/ each year the deduction is sought. - 1�1' �T�� �R
See reverse side la addilional instrucfions arM qualificafions. l
APPkam (awnero�mn7raG buye� ee m re _ // / _ 1
of real PmPenY az of
ir w. wna�
H name on
Name of mongagee w mntraa seUer
r
AGdress of rtarigagce or mntraa se0er
Name al asvgnee a ocher owner w ho6
rnm property in eny oNer
a?
❑ Yes
DeCUCUOn appmved In ihe artaunt of.
�-J
Mortgage / ConlraR'uMebtetlnPSS unpaiG as
Mamh 1. a�rten{ year
Remrtl
V CJ '
nw �u�aicate bewMC �
, , � �
7er and sW eG �Y. state. aM:
mortgage
51Ele, eM ZIP cotle)
If yes. what wunty?
I No
20 � 20 � 20
+3�]
ao��- �6�s�
or ewitade ovme!?
-r_-i..'___r, No
e0
— � � �ES� —
� � �
� No
I/ We cer�fy under ihe penatty of perjury Nat Ne above and foregoing infortnalior
owner / contract buyer of the afwementioned pmperry on date apD����n is filed.
� %4 L4.6L �
Person autlw�vEd Ey Gdy ex�
P4Eress at author¢ed person
aM stree4 �N �te. antl
aM sbee; cily, sYdle, an0 LP mde)
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