HomeMy WebLinkAboutMortgage_Frederick (4)ry� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou To p Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• State Fwm 43709 (Ri1 / 6-09)
� � PresviEeG M DePartmeM of La�l GovemmerLL Fi�nce '
� File Mark
INSTRUCT10N5: �
ma w;n,:
To be filed in person or by mail wdh the CounryAuditor or Counry Remrder o/ the oounty where the property is located.
Fitirg Dates: 1) Real Pmperty: Must file dun�g the year for which the deducLOn is soughG n_ n^ryry Auditor
2) Mobde / ManufaUUred Homes not assessed as Real Properry: Must file dunng tAe tweNe (72) monNs r-ilS
before March 31 of each yeur the deductian is sought. "�� — Recorder
See reverse side /or addrfnonel instnxtions and qvalifications. GIBSON .
[S! 9� C
Ta�org D' � Key number / kgal desaiptcn Recad numEC Page �wmCu
�-, - i�- 3oi-oao. a a 3-v a6 , o a ss�
Aaesaed vdNe d real poperty at of Ma(qage/ Cantrau 4debtadn�a unpaid as d Mortgage / ConYact u�Cebtedness unpaitl as d b Nie appOrani Me sok
Mart�h 1. armnt year Ma� 1. a�rtpent Y� tlate W appfi�[m kgal or eWilade o�nre/�
� a d� � b ❑ Yes ❑ No
tt ro. what 6 his / hc entl share ot intemsi? tl ovmad wiN somea�e oCwJ ttian wW�.'ud'rate with whnn
tt name m �emtd'u Eifte2nl than ihat of aPP��C �C��e Ge�'. is Me property in 0�: �nuelly Auessed
� Real RoPeNY ❑ ���Y �
Modle Flome IC 61.1-i
Nartre o1 rtxxtp39e8 at mntrarl seAer '
Pdtlress of nwrtga9x or mntrad sv�er (nunber erd sveet r1y. atate. erd LP ooda)
Name N assignee m oNri ovmer w holder of mortgage
AdC�s ot assignee (numhar erd aCee; rs}: smte. and LP oode)
Dces ePpli�m wm poperty in afry oUer I It yes. what muntyl I Wtat 7
couky m IManat � Yes ❑ No
COUNTVAUDf
DeEUCCan apprwed in Ihe amount of.
20 20 20 _ 20 _ .
Sig Ma W Coimb AuEitcr /f Ca
1 /
I/ We certify u Ne penalty of pe ' that the above arW foregoing infortnati
owner I mntract uyer ot ihe afwementioned property on date appliration is file
(numDeranESbee(
Pason auCiursed q' du�' executetl
pnism (number and snee; dry. stafe. eM LP cade)
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