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"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS c 7ow Year
� FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 93709 (R71 / 6-09)
�' ,�,� ` Presvibetl M �eparvnen of Lasl Govemmenl Fu�ance
INSTRUCTfONS: S �tl
Fwm filed with:
To be filed in person or by mail with Ne CounryAuditor or Counry Recorder o( fhe wunty wheie the pioperty is located.
Filing Da[es: 7) Real Pioperty: Must file dun�g fhe year /or which the deduction is sought. � ry Auditor
2) Mo6ile / Manufactured Horrms not assessed as Real Property.� Musf fiie dunng fhe fweNe (72J months a I� Co Recorder
6efo�e March 31 of each year the deduclion is sought. EU
a18S0 '
See reverse side lor additional instructbns and qualificatrons.
I t owneroroontracbuver-�eresbicb'wismrerersesi7el
Assessetl ralue d mal pmperty as ot
Ma�dt 7. aaren� YMar
�( M. W�id� 6 f16 / h2f GYdC� S�IdIE Oi Y
If rwr�e m reodd is 6lfemnt than Na
Nartre of rtwrtgagee a Vact se4er
�
Pddress of mortgagee ar mntra �
rwmEC / 1e9a1 desaiDYnm
2 (� - -� -10 3 -o�/. ��y- o � �
�MOrtgage/Contraaintlehtedn�sunpaidasof MortgagelCOno-actinCebtMni
Ma�ch t,g�rtent yrsr date of appGcation
Name M assignee w o�her owner or halder ot matgage
Adtlress ot assignee (number aM snee4 �Y. �fe. ard
Ooes applimni v+m property in any oNer
courLLy in IMafu?
❑ Yes ❑ No
Deductlon appmved in Ne amoum ot
zo_ �_
ee; (By; sb:e, aM LP code
ZlPtode)
If yes. what muntyt
�o�
� 20
0 9 �FS p
as d Is ihe epplirant ttre sale
legal w equilaNe o-xne/1
❑ Yes ❑ No
N awned wiM someone dher �han sPa+�. mdrate wiTh whmn
Is tt�e P�7enY in Guestion: MrvaM A55esse0
�.Real Pmperty ❑ ArmualyAssessed
WhatTa � �O �
— y5q o
I I We certify under ihe penalry of perjury that the above arM foregoing informatlon
owner I contract buyer of Ne aforemeirtioned property on date appiication is filed.
Sigrewre (owneYS hAname) � �f .
(numbe� artl �e4 �Y, �re, and ZIP aotle)
aWwReA Ey.QidY ei`ecuted Pawer o(AUVney w by
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