HomeMy WebLinkAboutMortgage_Miley'°'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co r
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
- � State Form 43)09 (Rt1 / 6W)
�' � Presaibed by DepartrtmM of tmal Govemmant Firence
"" 'le . UlU
INSTRUCT10N5: . F� q� �
To be filed in person w 6y maif wifh the CounryAUditw or Counry Recorder o/ Ne county where the property is located.
Fdlrg Dates: 1) Real Property: Must fde durirg the year lor which tha deduction is so�ghL Gpupry quditur
2) Mo6de / Manu/actured hbmes rat assessed as Real Properly: Must file duAng fhe tweNe (12) monMs �G3 /fa �
befora March 31 of each year the deduction is swghL Courtr�/Kecorder
See re rse side for additiona/ instnictions and quzlifications. G IBS
AppG �(owrqr or amfraC 6uyer-�5+r'b'oru m revarm sde) '
n �. -
AssesseC ra4m d real RopenY �: d
Mem7� 1. anent year
rc �o, �i �s na i n�, e�a �.e or �u
I' �wrie m remd is Eirte2nt lhan that a
rlartre ot mongayea «crnvaa uou
Mdress d rtnrcgaqee a contraa se0u
Nama M ass�ee or aNa owner m hd
Adamss o/ astignee (numGar erd atree
Does apqimnt ovm property in any ottp
munry m InOena? ❑ Yes
DMur�on sPM� 4i Ure amount of.
I legal desaip' Retad iwwm0er .. Page num6er L
. _ _ioi-000.���_oa6 ao�o �
b�qage/ ContraG irdeGedness unpaiE az of Mortga9e I Contraa trMebteCriess unpaid as W b Me app�xant the tde
IardL1. artmt p date M aV� kgal a eQWtaNe aMnCi
O a. p ❑ Yes ❑ No
u owneE wim somrone oNer than spaue. S�Arate WN wtnm
aDP��I Inditate bebw
�
n'umbel and streeG �: ffite, aM 2
u d mort�age
rdy, slate, end ZIP Catle)
1I yes. what countyl
❑ No
2p _ � 20 - � 20
I/ We cerUfy under Ne penatty of
amer I mntraq buyer of the afor
AAEresa af eWiaftreE pe�sm
20 _
ry that the above foregoing inf
rttianed property o ate apPlicatior
' ' ; state, a IP code)
>f Atlomey or Dy IC F.-12-0.7
street �M sfate. enCLPCOde)
Is tlm propeM1y m purstm: Mnua�y Assesse0
❑ Real PmpertY Q Armual�Y Pssessed
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