HomeMy WebLinkAboutMortgage_McGregor"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
___ + FOR DEDUCTION FROM ASSESSED VALUATION
• Sbla Fortn 43709 (R11 / 6-09)
,' � PrPSaiGetl M DePartmeM W Loml Govemmenl Fuunce .
File Mark
WSTRUCTIONS:
To 6e (led in person a by mail wifh the CountyAudiror or Counry Recoider o/ tAe counry whe2 the property is located. �
Fding Dates: 1J Real Pmperty: Must fJe during the year /or which Ihe derlucUon is soughf. �❑ � q�d��
2) MobAe / Manufactured Homes rat assessed as Real Property: Must h7e dunng the hvelve (72) months
betora March 31 0( each year the deduction is sought. u Recorder
SeereversesidelwadUi6onalinstnrctionsaridqualifiwtions. GIBSO AUDITOR
App6rant(ownerorcontrartbuyer-^eerest�iwssmrei.xrs�i e) �
Tan Distr�ct Key iwmDer / legal OescriDtion // Record number Page numEri
a� - 9- �� 303 -000. 3�/-0 7. � an��
A�sed ralue of real picper;y az o1 Mortgage / ContraG'uWebte�ness unpaid as of Mongage / Con�'uWebieOness unpaid az of Is the applkant the sde
� 7, dertni ymr Mamh 1, airtent yr8r/� Q l date of application I�jal a equliade ovmeR
/0 Oi7U ❑Yes❑No
If M. Wh8t IS hi5 / Ile! 0Ydf15h21B Oi Ifl}CRS11 I/ OWIIBd W1N SOTCWIC othM C13fI SVW�. IM%21C MVh WhOrtl
If twne on 2md 5 QMurnt Nan Ihat of aPP��l rtMifate Delow. Is property in CuesEOn: Mmia%PSSessed
�CdI�IO�EKY ❑AtII1tla�yA555C555Cd
. �� �1iObI�E HOR12 i�C. �Yi.i-�
Name oi mort�agee or mnVaU seller
ACtltes of mortgagce w mntrad se0er (nurr0er and stree4 �y. spfi. aM ZIP �
Name M assi9nee w otha ownet or holder of mortgage
AdAress ot asvgnce (number arM slree4 �Y, slste, aM Z/P o2otle�)f p //.�
✓v`O / /
Dce5 applitant bwn property in a�ry oUer It yes. what wunt7/1
munry in IMana?
❑ Yes ❑ No
zo � zo � 20
a9 Pr -
What Taang D'slriU? Has Ihis �im Oaen re9ueste0 m P�Y
for w�rerq Y� � r� _. r-�
zo_ zo_ llra�vcr \O...t�..�.!!.'.....
Caunry ?�-
Card NO. ...d�.'•. ��?......
I/ We certify under Ne penalry�perjury thal tt�above an0 toregoing intortnalion is We and co�
ovmer I mntraa buyer of the a oremention �1�operty un date application is filed.
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'-%a (a � �5-i7�.t I1��5-�-. a� -�n �-��SZi Lnn.tie� �/V Lf %!o �f �'
rson auJ�o� Dy dWy exewted Power of Attomey w by IC 61.t-12-0.7
PCtlmss of aWror'ved person (number arM street �: sbre,
Date (rtbNh. dxY. Y��