HomeMy WebLinkAboutMortgage_Vaal"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun T s ip Yea
: , FOR DEDUCTION FROM ASSESSED VALUATION �
y Stata Form 43709 (R71 / 6-09)
��w � PreuriOeE M�PartrrieM of local GovemmeM Fumnce
. File Martc � O lU)U
INSTRUCTIONS:
To be filed in person or by mail wiM the CountyAurlitor or Counry Recorder oi the counry where the property is located. F� �� �
Fdirg Dafes: 1 J Real Property: Must file dumg fhe year for which tha deduction is soughG �, Coun �y�
2) Mo6da / Manulactured Homes rat asseued as Real Property Musf file during the nvelve (72) monfhs �ON ,.,: / '"`'�,
before Ma/cA 37 of each yBar the deduUion is mught. LJ caaMt�p�qEyr A
u ,. R
See reverse side 7or addifionel instructions enA�alifications.
AppGranl(cr9frmm�traGbyu-seemst�Ctiwism velsesiCe)/ I
- I- y- oo-aoa. �l- oa�
Actessed vaNe d real RoP�Y as of hbrtpage / Conbau trdeMedness unGaid as W Mangage / Ca
Mam� 7, yr¢M year Mamh 1, airtent yenr Eate af appfaa
111W. Whd� L51YS I h¢f Cl[2G Sh818 Oi Ill}PJ25i?
nare m remN is 6lferait lhan
�� � �,�
mntract se0er (num6ei ard sbae; rd}f Yate. aM LP cadej
Name at assignee or otlxr awner w hdder N rtqrtgaga
ldaress ot a�gnee (wmeererd saee4 �l: stete. and
Does a�ion[ ovm poperty in eny oMer
counry in IMana1 � Ye5 ❑ No
Detluceon approved in iha amount oE
20 20 _
what muntyt
COUNTY
Recad ramber Page `wm6ei
o?O /O / -
iMebtetlness un0ai0 as d La Ne epprxant Ne st
Y25 L J No
If owneE wiM someone oNer t�an spouu.
� D�O�Y in 7ues0on: MnuaM Assessed
� a�oa�ro � nrQ,�any w�w
, �p!O
C, \O , • �
O � �`` \�;� �° p�6
o�o-�aa �j\�•''�.�y0�(�•
C�`, � �1 .a ❑ No
2p _ 20 _ 20
Counry
�— � �_
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I I We cerOfy ufWer Ihe penatty ot perjury Mat [he above aM foregoing infortnation is We and cortect arM that the applirant is a resident of IrWiana aM
owner I mntraU buyer af the aforementioned property on date apP��� � fiied.
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aAtlmss d appfeani (numberarM streeL �: state, and LP coda)
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