HomeMy WebLinkAboutMortgage_RiveraSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ip r
_ FOR DEDUCTION FROM ASSESSED VALUATION
� Slate Form 43709 (R71 / 6-09) -
�' Presaibed by DeP��� ot Loml GovemmeM Fi�nce
,w File Mark
�wsrRUCnoNS:
To be fiied in person or by mail wifh the CountyAuditor or Counry Recorder of the counry whe`e the property is located. F� ��
Filing Dates: 1) Real Pmperty Must file dunig the }rear for which Ihe deduction is soughG ��. f' "`1� �
2J Mobile / Manufactumd Homes rrot assessed as Real Properly: Must file dunng the (weNe (72) months � �unt�i `� er
before March 31 o/each year the deduction is sought.
See revers 'de for additional insVUCtions and qualificafions.
' Appliwnt ' er woontratt buyer - s m9nitions rn rererse sile)
:.J%� I
Tari ''cc Key n ber/ I des/aipUOn
� � /��
', A.sess� raLe aF inal poperty a of Mor(qage / Contract u
'. MarM 7. amsrt ym Mamh 1. airtent ymr
'i If m, what's his / her e� share af interrsi?
�I tl�me on tecad a L'ifirlent Nan that of appfimn; uMilate bebvr.
Name W mort9a9� � mntraa
other owner or holder N rtnrtgage
Atltl2ss of asvgnce (numbera� sbee4 �}: s+ate, aM ZIP cotle)
Oces epplksnt oun pmperty in any oNer
Cd111h 111 �11401N� n ..
�
amouni o`
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If owned w@h wmeone wher Ihan
rw�r'
COUNTYAUDROR �
zo 2o x
Counry
I I We certify under the penalty of perjury ttiat the above aM foregoing infortnation is W e and
owner I contrad buyer of Ne aforementioned pmperty on date apDlicalion is filed.
�
Person auNOirsetl by dtdy ezecureC
sheef, riry.
person (numberaM sbeel, cdy, state, aM ZlPaode)
•. • • .-
as of h Ne app�xart the sde
k�l a e�alacle oxneY+
� ❑ Yes ❑ No
�knm
Is Cre prapmiy in Qu�tirn: MnuaP/ As^.essed
� Real ProPenY O !�^!�?Y �
Has Ni5 deduaion Deen requeste� m prapelty
(OfWrtEN)'P2(� ❑ Y�
❑ No
Di•a�ver NO...d�..,��1.........
Card NO.•.: 55'U..... ...
� $(� W 7(�.�' �. �.
Date (monCi. daY, YaaA
1T_ 1, I1
Date (monN, daY• Y��