HomeMy WebLinkAboutMortgage_Reinhart (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:�--..
: FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm G3709 (R71 / 649)
�' �.r I PresaiOeG M �ePartmen� o( Local Govemmenl Fnance
�NSTRUCTIONS: f�� gor� W
To be filed in person or by mail with [he CounryAUtlitor or Counry Recorder of the county whe2 Ihe properry is locatg= � 2 O L� I I��
Filmg Dafes: f) Real Property: Musf frle during the yea� for which the deduclion is sought. � County Auditor
2) MobBe / Manufactu2d Homes not assessed as Real Propelly Musf file dunng the tweNe (12J moMhs�
6efore March 31 of each year the deduclion is sought Counry Reoorder
1
See reverse side for additronal instruUions arM quali�catbns. , r � �T �
App6�1(awnercr mntrarl by2� -�ee restric�ns m mverse sde) • . J/
\
� �Ka� �l9 iS-.3o�l-000. �sq_oa�
asof MoRgage/COntrac['vWebtednessunpaitlasof MortgagelContractim
Mamht,artenlyear tlateofapplication
Ii m, what is h's I hu esaG
if name m'emtl is Cilfemnt Nan that of appGran4
Name of rmtgagee or cono-aq seller n_
Afld255 0( martqa9ce or conUacl seAer (numbe� aM strdo5, ciy, sta[e, aM ZIP coda)
Name o( assignee w otlrer owner or hdder ot mwtgage
Address ot assignee (number arM stree4 dry, slafe, aM Z1P code)
Oces ap�i2N oxn yoperty in anY �er I( yrs, whal munry?
cwnry in InEiarw?
❑ Yes ❑ No
20 I 20
lweitor
If owrreC with someorie
RemrC number Page numOrl
/ 1 3.3
btetlness unpaiG as of is Ihe applirant the sde
legal or epui�2de ownM
) O D ❑ Yes ❑ No
spouse. iMicate with wtrom
Is iM property in Vuestion: MnuaOy Assessed
❑ Rea� arovertv ❑ ��r�
-
IiE�M/�A/�- ,5�6 T
���
11-�y33
COUNTYAUDROR
20 _ 20 20 _
Counry
I/ We certify urder the penalry of perjur�/Ehat ihe
owner / contracl buyer of the afaementioned proi
sLeet cify, sfafe, antl
ri._��
Da�e (monM. tlaY. YTah
m ptopetty
� ❑ No
20 _
nd foregoing infortnation is We and cortecl and Nat ihe appiinnt is a resident o( IrWiar�a and
date applicalion is filed.
Date (monfA, day, yea�
Person auUnr¢cM Dy d�dy ezecuted Power of AtlomeY or by IC Gl. t-12-0.7
AEtlress o! author¢e0 person (number ard sLee; ciry, state. anE LP mtle)
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