HomeMy WebLinkAboutMortgage_Braden^'�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
� FOR DEDUCTION FROM ASSESSED VALUATIO�1 ���
:.__ . �.
State Fwm 43709 (R17 / 6-W)
S I Presai0atl by DeparlmeN of Lmal CovernnRM FNance
File Mark
INSTRUCl10NS:
I,'�,I9(� Fortn hled with:
To be filed in person or by mail with fhe CountyAUdROr or Counry Recorder o� the county �Wfal& UE pro is located.
Fil"mg Dates: 1) Real Property: Must file durirg the year for whicA the deduclion is soughl. a2r,;.�,� � County Audimr
2J Mobde / Manufactumd Homes rrot assessed as Real Prnperly Must Ae �ari/�. tlka " Vmonths
6efae March 31 of each year Ne deduction is sought Counry Remrder
Seereverseside7oradditionalinshuctionsandqualfications. ,,,,,�„�� enuNTY AUDITOR
��� � �
Aysessetl vdue d real woperty as ot
Mamh 1, curentyear
I( rw, what I5 his / tcer eract share of inte�e
legal Cesaiption
thal o( aDP����• ��te bebr.
Name W rtnrtgagee « mnbaU seller
AddRSS of mM9a9� or mntrad sWer
Name of assi�ee w othef awner or
sfate.
mortgage
ciry, state, an0 ZIP ootleJ
Does apptitan� ovm p'opUly in arry oNa If yes. Mfiat wunp?
munryinlnd"ana? f_'1_..__ 1='I_.. _—_ _
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C�I�Ci ��. ..�57��.......
��%�/ �� • On
- e�� . I, a-o ac� Recard numDer � Pape rwm �T
ess unpaid as of Mortgage I Cmtru1 ifWehtedness unpaid as of Is Ne ap�cent Ne wk
i
tlate of aDP��+ �egal or eQuib6le oxneY?
� ❑ Yes ❑ No
If owne0 wiM someone other ihan spouse. iMinte with wMm
Is pre property in questim: Mnua%AZSessed
❑ Rea� Pmcertv ❑ /vmualy' Assessed
Whal Taritg D'¢tncl?
)UNTYAUDROR
20 20
Counry
�rea «� v�r
Yes ❑ No
20
oa� c�rwnn. dar. rear�
20
I I We certify under Ne penaly of perjury that the above aM foregdng m(ortnatian is We and cortect and that the appluant is a resident of IrWiara antl
owner I contracl buyer of fhe atorementioned property on date applicatbn is filed.
yam o p9lname) �'�/%/ � DatalnniN�.daY.Yea�
and
)n�a/-)�C' �'1re
ezecutetl Power o( Attorney or by
Pdtlmss of auNasseC person (num0er aM snee4 ury. state, and ZlPCOde)
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