HomeMy WebLinkAboutMortgage_Folsom (3)•� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ : FOR DEDUCTION FROM ASSESSED VALUATION
:• State Fwm 93709 (R71 / 6-09)
� � Presrribe0 q' Department ot Local C»vemmeM Fuumx '
� File Mark
INSTRUCTIONS:
wm t�
To 6e filed in person w by mail wifh Ihe CounryAuditw or Counry Recorder o7 the county where the pioperty is ted.
Fitirg Dates: 1) Real Properry: Must fde durirg the year (or which Ne deduction is sought. u itor
2) Mnb�7e / Manu/ec2red Homes rat assessed az Real Prtiperty Must file dunrg the hveNe (12J months I''I
6efore Ma�ch 37 0/ each year Ne daduction is sought. MA ��1__I � Gou!in' Recorder
LUIII
See revarse side (or Rional inshuctbns and qualificafions.
,npa�m(owre. I //l�iY l N/onc�('.(� n 1�6L1n.-. P'/a`�.Q�S
As�eE raNe U real PmPertY as N
i1.armaYear
tt ro. what ls tris I trer cuC stwa of u
tt name m recwa 6 C@aan than Ma
Name of rtnrmavro m m�trad se4er
Key nmber / kgal Ian �'.
6- 14-I 8-30�-000. �30-0
MorlgaQe / Contract iMebtetlness unpaid az N Moriga9e I Contraa inc
of moM19s9� v mntract se�er (num6er end sbeeL
Wme at asignee or dher awner or hdder
Deb�r
and LP mde)
rsasada�a.�......�'""___"'_.. v)
Y.4�/.`.i �....... ia[county?
Dra\\'er i�0...
" ��✓0..........
CarCl \O. ........... .� _
�LH,00�.°° �'O4� `�oB-aor�� -
� °+— I 20—
I I We certiy uMkr�ihe penal
owner I contraa dfjyer a the
. °gPiPY�.h�^am°) A�
::u::aa
az
� A OITpF�C+y
o< �JlJ
Is Ne eppBmnl Ne sde
Iegal or epuitade owneR
❑ Yes ❑ No
spwsse, i�dwate with wt�wn
Is tice property in Quesimr� Mrwe�yASSCSUd
❑ Real ProPaKY ❑ %��!�Y.�
lMiat Tering Districtl Has
��
COUNTYAUDROR
2o i zo
O�Y
❑ Na
2°— � z°—
���iVl�yQ/��fL� ��� ��� I O-/ C7
that Ne above arW (oregoing infom�alion is We and cortect arW that the appiinn[ is a resideni of Indiana arM
ned OroPertY � date application is filed.
ss d appfKant (nuhber ard stmet tlry, state, and
E. 111�Qw.� Sfi �-
py pWy esecuted Power of Attnney a Oy IC 67.7
Address o( aiMa'ved persm (num0e� aM s0ea4 �: sta(e. antl LP ooda)
DatB (mnnN. tlay.