HomeMy WebLinkAboutMortgage_Adams (6)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION .
State Fam 43709 (R11 / 6-09)
� ,�,� � Presaibed M �Fa�rit of Loral Govemment Fuance � . . t � .
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INSTRUCTIONS: M �
To be filed in persan or by mail wiN the CounryAuditor or Counry Recorder o/ fhe camry wl�ere the property is located- ��
Fifirg Da[es: 1) Real Properry: Must file dun�g the }rear for which Ne deduclion is mughL � Counry Auditor
2J Mobde / ManuFadured Homes rat assessed az Real Property Must file dunng the twelve (12J months n,,�
6efora Marctr 37 0/ each year the deduction is sought. �� � cs �a.uiN Recorder
See reverse side foradUilional instrucfions and qualifications. - NTY AUDITOR
Ap�t (owneror contrdC bN'er - see reatrktOns on reverse Sife) . _
�a � �.ey �.n�wu � xym ucwy�.�u�
�,� a!n -�9 - s-�o -odt. o - o � /o
Atxssed vapie d real praper;y as d M�(p�g e I Conbaa intlebtednass unpaid as N Monga9e / CanaarS
Maitl� 1. wient Y� Mam3� 1. airtent ,l date o1 aVP��
I ��� D�V
n no. what m ns / her exae share ot intrRSta rc ovn,ea r;m sanew�e mier i
tt name m 2mN "s EHterent than Nat o( aPP��t trdirate Delow.
Name af rtnngagee a mntrari seuer �� �'�-��
AGd� af rtartgagee v oontrad se0er (numhar end street �1: smte. and LP code)
Name W assignee or oNC owner or hdOer of navtgage
AOtlmss oi assignee (numDer arM atraet �Y, stele. and LP ootla)G��" �'
Ooes epptimr�t rnm wov�Y in any otlm.r tt ynv. what munty7
m�^q'�me�aa r-i .,__ n .�_
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a„�,�� ar.
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couNnau
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I I We certfy ufWer�(e penatty of perjury pSat the above arW toregoing intwm
owner I contract buver of the afo2mentidned property on date apDlication is fi
✓YOy /RoQuoisOR. �P,,?S/�}NcN,h
Pason auUn�'¢eE Dy tluh/ exewie0 Power o/ AncmeY w by IC G7.1-12-0.7
ldtlt¢s af aWia'¢Ed pereon (number antl sbeet �4Y, s�te. anE LPmtle)
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Distrv37
RemN number Page numba
�n�n /9D
Yes U No
spouse. ina�te wim w�mm
Is Cu pfoperty in purstion: MnuaDy Assesu0
� Real Property ❑ Armually Assessed
J s � �� �
Has Ns detluction Oeen �uested at property
lor wnent yeaR � r� .. �.
_x,_ --•-- = zo_
Dra���e'r NO.v�: �..1. o,-.....,�
Iq �� : o( IrWiana and
Card NO. .... .. ....
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